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Medicare Claims Manager

  • Location:

    Georgia

  • Sector:

    Life Insurance

  • Job type:

    Permanent

  • Salary:

    401 Benefits

  • Contact:

    Cem Goksungur

  • Contact email:

    Cem.Goksungur@oliverjames.com

  • Job ref:

    JOB-032024-242264_1710983061

  • Published:

    5 dagen geleden

  • Expiry date:

    2024-04-20

Medicare Claims Manager

$90,000 - $100,000

Atlanta, GA

The Medicare Care Manager Team Lead facilitates the successful execution of the Integrated Case Management program by providing day to day supervision and applying problem solving skills to ensure the delivery of member- centered case management, improved access to community resources and improvement of overall health status of members.

Job Description

  • Provide clinical guidance and supervision to assigned Case Managers and Case Management Associates in order to promote efficient and effective delivery of case management services.
  • Supervise day to day activities in the field to make certain that case management services are provided in accordance with clinical guidelines, established processes
  • Conduct 4 - 5 field visits per day to mentor and evaluate staff, problem solve and implement strategies to facilitate the overall goal of the program.
  • Supervise the entire case management workflow including case selection, interventions and goal setting, follow-up/follow-through activities, documentation, and escalations.
  • Ensure case management activities are conducted in a safe, efficient, and effective manner to promote continuity and quality of care.
  • Review, develop and modify day to day workflows to ensure timely completion of visits and attainment of productivity benchmarks.
  • Perform ongoing quality review of cases to ensure accuracy and compliance.
  • Evaluate and document staff performance; coach staff to improve both quality and quantity of skills attaining optimal performance.
  • Utilize data to track, trend and report productivity and outcome measures; work with the management team to implement necessary improvement strategies.
  • Use expert verbal and non-verbal communications skills to motivate and gain co-operation of members and their caregivers.
  • Resolve issues and mitigate conflict encountered during daily operations; appropriately escalate issues to the Sr. Director of Case Management or Designee.
  • Identify and report potential risk, operational opportunities and barriers encountered in the field, proactively share with the leadership team.
  • Conduct monthly audits for the purpose of departmental/organizational reporting and providing formal feedback to case management staff.
  • Create and submit operational weekly/monthly/quarterly reports.
  • Work with the leadership team to develop and implement ongoing training and development efforts.
  • Actively participate in staff training and meetings.
  • Encourage regular communication and inform staff of relevant departmental and organizational updates.

To know more, apply for the position including your resume and I can reach out to discuss confidentially.

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