Job Summary
Team Lead, Integrated Care Coordination - Waiver, serves as a working leader responsible for both the day-to-day operational support of assigned Care Coordinators and the direct management of a reduced caseload of MyCare HCBS Waiver members. The Team Lead serves as the first point of escalation for clinical and operational issues and supports achievement of program goals, regulatory requirements, quality standards, and member outcomes.
Essential Functions
- Provide day-to-day oversight and direction to assigned Care Coordinators.
- Monitor daily operational workflows and ensure timely completion of assessments, service plans, contacts, authorizations, and member outreach activities.
- Serve as the first level escalation point for staff questions, barriers, member concerns, and operational issues.
- Facilitate team huddles, case reviews, and workload discussions.
- Assist with caseload balancing and workload distribution.
- Provide consultation regarding HCBS Waiver requirements, service planning, person-centered planning, care coordination, and service delivery.
- Assist staff with complex member situations, transition planning, service gaps, provider issues, and member health and welfare concerns.
- Support implementation of care plans and service plans in accordance with MyCare HCBS Waiver requirements.
- Assist staff with identifying community resources and supports to address member needs.
- Support continuity of care activities during transitions between settings, providers, programs, and care coordinators.
- Conduct routine documentation audits and quality reviews.
- Monitor compliance with assessment, service planning, and outreach timeframes.
- Identify trends, risks, and compliance concerns and escalate to the Manager.
- Assist in preparation of corrective action activities and quality improvement initiatives.
- Monitor adherence to policies, procedures, workflows, regulatory requirements, and operational expectations.
- Coach, mentor, and develop assigned Care Coordinators, providing real-time feedback and performance coaching.
- Partner with the Manager regarding performance concerns, training opportunities, and professional development needs.
- Assist with onboarding and training of new staff and support annual competencies and ongoing staff education initiatives.
- Partner with providers, Community Partners, delegates, vendors, and internal departments to support member needs.
- Participate in interdisciplinary meetings, operational workgroups, and stakeholder meetings as assigned.
- Serve as a resource regarding HCBS Waiver program requirements and operational processes.
- Maintain a reduced caseload as assigned.
- Serve as the primary coordinator or consultant for High-risk members, Members with repeated incidents, Complex transition cases, Members requiring multidisciplinary intervention, Members experiencing service gaps or Members with significant social determinants of health challenges
- Perform any other job related duties as requested.
Education and Experience
- Associates degree in healthcare required
- Bachelor's degree in Nursing, Social Work, Human Services, Healthcare Administration or related field preferred
- Three (3) years of care management, care coordination, HCBS Waiver, LTSS, Medicaid, or managed care experience required
- Prior leadership experience is preferred
Competencies, Knowledge and Skills
- Strong knowledge of MyCare HCBS Waiver and LTSS programs.
- Knowledge of person-centered service planning principles.
- Understanding of Ohio Medicaid, waiver requirements, and managed care operations.
- Strong coaching and mentoring skills.
- Strong organizational and problem-solving abilities.
- Ability to manage competing priorities in a fast-paced environment.
- Strong written and verbal communication skills.
- Ability to analyze performance and quality data.
- Proficient in Microsoft Office applications.
Licensure and Certification
- Current, unrestricted Registered Nurse (RN) license in state of practice or current, unrestricted Licensed Social Worker (LSW) in state of practice is required
- Case Management certification preferred
- Must have valid driver's license, vehicle and verifiable insurance. Employment in this position is conditional pending successful clearance of a driver's license record check. If the driver's license record results are unacceptable, the offer will be withdrawn or, if employee has started employment in position, employment in this position will be terminated
- To help protect our employees, members, and the communities we serve from acquiring communicable diseases, Influenza vaccination is a requirement of this position. CareSource requires annual proof of Influenza vaccination for designated positions during Influenza season (October 1 – March 31) as a condition of continued employment. Employees hired during Influenza season will have thirty (30) days from their hire date to complete the required vaccination and have record of immunization verified.
Working Conditions
- General office environment; may be required to sit or stand for extended periods of time
- Up to 25% (regular) travel may be required to travel to different locations, including homes, offices, or other public settings, to perform work duties
Compensation Range
$72,200.00 - $115,500.00
Compensation Type (hourly/salary)
Salary