Medical Policy Manager jobs in Scranton, PA

Description

POSITION SUMMARY:

The Manager of HIV Medical Case Management is a highly motivated and experienced individual responsible for overseeing the coordination and delivery of comprehensive medical and social support services for people living with HIV/AIDS (PLWHA). This role is pivotal in ensuring the effectiveness of the medical case management program.

Requirements

DUTIES & ESSENTIAL JOB FUNCTIONS:
While living and demonstrating our Core Values, the Manager of HIV Medical Case Management will:

• Demonstrate expertise in coordinating, directing, and managing all medical and prison linkage case managers.
• Regularly assess and enhance the skills of case management staff through mandatory bi-weekly supervision, documented on the staff supervision log.
• Implement and oversee quality improvement initiatives to regularly assess the effectiveness of case management services.
• Act as a mediator in case management-related conflicts, promoting a positive and collaborative work environment.
• Implement conflict resolution strategies and facilitate team-building activities.
• Oversee all case management referrals and delegate to case management staff as appropriate.
• Consult with patients as necessary for purposes of solving complaints, dealing with patient care, etc.
• Assist in the review and approval of all requests for payment of any patient services related to funding.
• Oversee coordination/referrals with Regional Housing Case Managers with the United Way of Wyoming Valley.
• Oversee the implementation of Uber transportation services, including bill payment and utilization reporting.
• Monitor and prepare monthly invoicing reports in conjunction with the RW Compliance Coordinator. This report is due to the RW Grants Administrator by the third business day of each month.
• Oversee and approve all PTO and mileage reimbursement requests.
• Provide staff education and training on Ryan White Part B services. All services listed on the PA Department of Health Program Standards must be reviewed at least once per fiscal year. This will be documented by having a sign-in sheet for those in attendance for each training.
• Ensure that all staff members receive training on cultural competence and sensitivity to effectively serve a diverse population of PLWHA.
• Incorporate culturally responsive practices into the delivery of services to enhance patient engagement and satisfaction.
• Facilitate ongoing professional development opportunities for case management staff, staying abreast of the latest advancements in HIV/AIDS care and related fields.
• Encourage staff participation in relevant conferences, workshops, and training sessions.
• Be responsible for the creation and implementation of a Ryan White Part B workplan. In this workplan, there will be clearly defined goals and objectives, activities and tasks, outcomes, persons responsible, and timeline for completion.
• Be responsible for the submission of a monthly report to the RW Grants Administrator to ensure the department is on track for financial and programmatic responsibilities. This report will be due by the 5th business day of the following month.
• Advocate for the expansion of funding for the case management program by creating proposals backed by data.
• Lead and develop partnerships with local community organizations to provide and respond with access to services.
• Be responsible for the distribution and management of an annual patient satisfaction survey. All results will be reviewed and followed up on to ensure high-quality client care and satisfaction.
• Develop standard operating procedures to ensure program effectiveness.
• Maintain a caseload of up to 5 clients. 
• Perform other duties as assigned.

REQUIRED QUALIFICATIONS:

• Bachelor’s degree required, Masters preferred, along with two years ofexperience performing Social Work and/or MCM activities.
• In-depth understanding of HIV/AIDS care, treatment, and support services.
• Strong knowledge of medical case management principles, including coordination of healthcare services and social support.
• Familiarity with Ryan White Part B services and compliance standards.
• Demonstrated experience in supervising and leading a multidisciplinary team of case managers preferred.
• Proven ability to develop and implement strategic plans, workplans, and quality assurance programs.
• Strong leadership and decision-making skills with the ability to inspire and motivate staff.
• Excellent communication skills, both written and verbal, with the ability to effectively interact with diverse stakeholders, including patients, staff, healthcare providers, and community organizations.
• Exceptional interpersonal skills, with the ability to build and maintain positive relationships with team members and external partners.
• Proficient in data analysis and interpretation to inform decision-making and program improvement.
• Strong problem-solving skills, with the ability to address complex issues and implement effective solutions.
• Experience in financial oversight, including budget management and reporting.
• Familiarity with grant writing, proposal development, and reporting requirements.
• Demonstrated cultural competence and sensitivity in working with diverse populations, ensuring inclusive and equitable service delivery.
• Proficient in using CAREWare and Medent for data management, reporting, and communication preferred.