Home and Community Based Services Manager

Company: KEPRO (The Keystone Peer Review Organization), Inc
Location: Denver
Posted on: February 23, 2021

Job Description:

If you are a job seeker with a disability and require a reasonable accommodation to apply for one of our jobs, you will find the contact information to request the appropriate accommodation by visiting the following page: Home and Community Based Services Manager KEPRO is a rapidly growing national quality improvement and care management organization. We work to ensure that over 20 million people receive the right care, at the right time, in the right setting.---KEPRO is seeking resumes for a highly experienced HCBS/LTSS management professional. Home and Community Based Services Manager Summary Description Under the direction of the Program Director of the Colorado Utilization Management Program, this position provides overall leadership for Long Term Support Services and Home and Community-Based Waiver UM program activities for a contract with the Colorado Department of Health Care Policy and Financing Office of Community Living, serving Colorado Medicaid members. The LTSS Manager oversees a department including, at a minimum, Children's Extensive Support waiver, Home and Community-Based Services waivers, Over-Cost Containment reviews, Critical Incident reviews, and In-Home Support Services Cost Containment reviews. Accountabilities

• Assures accuracy and timeliness of all applicable review type cases within contract requirements.
• Assesses, evaluates and addresses daily workload and queues; adjusts work schedules daily to meet the workload demands of the department.
• Analyzes productivity of reviewers conducting reviews of Enrollees' long-term supports and services (LTSS) and/or Home and Community-Based Services (HCBS) needs and monitor the provision and outcomes of those services, including quality of outside agency documentation.
• Identify clinical staff orientation and continuous learning needs and in collaboration with the Program Director, develops and implements plans to address those identified learning needs.
• In collaboration with Program Director, responsible for the quality monitoring activities including identifying areas of improvement and plan implementation of improvement areas.
• Maintains current knowledge base related to review processes and clinical practices related to the processes; functions as the initial resource to assigned clinical staff regarding all review process questions and/or concerns.
• Functions as provider liaison and contact/resource person for provider customer service issues and problem resolution.
• Performs all applicable review types as workload indicates.
• Foster positive and professional relationships and act as liaison with internal and external customers to ensure effective working relationships and team building in order to facilitate the review process.
• Attends training and scheduled meetings and for maintenance and use of current/updated information for review.
• Maintains current knowledge base related to LTSS/HCBS review and assessment processes and clinical practices related to the processes.
• Cross trains and perform duties of other contracts within KEPRO to provide a flexible workforce to meet client/customer needs. The list of accountabilities is not intended to be all-inclusive and may be expanded to include other duties that management may deem necessary. Qualifications---
  • Active unrestricted RN, Licensed Social Worker or other applicable State and/or Compact State clinical license per contract requirements.
  • Graduation from an accredited Associates or Bachelor's Degree Program.
  • Case Management Certification preferred.
  • Behavioral Health (adult or pediatric), TBI, LTSS, or HCBS experience required.
  • Health-related Master's Degree preferred. Knowledge, Skills, Abilities
    • Knowledge of current NCQA/URAC standards strongly preferred.
    • Knowledge of the organization of medical records, medical terminology, and disease process required.
    • Strong clinical assessment and critical thinking skills required.
    • Medical record abstracting skills required.
    • Ability to work in a team environment.
    • Flexibility and strong organizational skills needed.
    • Must be proficient in MS Office and internet/web navigation.
    • Work effectively with individuals with diverse disabilities and cultures.
    • Problem solve and prioritize and meet deadlines.
    • Familiarity with Independent Living issues and philosophy.
    • Familiarity with Community resources and local service system for persons with disabilities.--- Experience---
      • Minimum of 3 years of clinical experience in a home care, skilled nursing facility, community-based Care Management, or residential care environment required.
      • Minimum of 2 years health system quality management or related clinical experience.
      • Minimum 3 years direct behavioral/mental health experience in a clinical setting or other applicable State and/or Compact State clinical experience or license per contract requirements.
      • Previous workload management experience required.
      • Experience with State Medicaid programs strongly preferred. Mental and Physical Requirements The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations will be made as required by law in an attempt to enable an individual with a disability to perform the essential functions of this job. While performing the duties of this job, the employee is regularly required to sit for prolonged periods of time; key and/or control objects; interact extensively with internal and external customers; occasionally lift and/or move objects weighing up to 10 pounds; and occasionally travel within the state. KEPRO offers challenging careers, excellent benefits and opportunities for advancement. For consideration, please submit resume and cover letter with salary requirements.---Only those candidates identified for an interview will be contacted.---No Phone Calls Please. Visit our website at---www.KEPRO.com---for more information on the KEPRO Family of Companies. EOE AA M/F/Vet/Disability KEPRO is and Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran. Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities The contractor will not discharge or in any other manner discriminate against employees or applicants because they have inquired about, discussed, or disclosed their own pay or the pay of another employee or applicant. However, employees who have access to the compensation information of other employees or applicants as a part of their essential job functions cannot disclose the pay of other employees or applicants to individuals who do not otherwise have access to compensation information, unless the disclosure is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding, hearing, or action, including an investigation conducted by the employer, or (c) consistent with the contractor's legal duty to furnish information. 41 CFR 60-1.35(c)

Keywords: KEPRO (The Keystone Peer Review Organization), Inc, Denver , Home and Community Based Services Manager, Executive , Denver, Colorado