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180,000 people in over 40 countries, Capgemini is a global leader in
consulting, technology and outsourcing services. The Group reported 2015 global
revenues of EUR 11.9 billion. Together with its clients, Capgemini creates and
delivers business, technology and digital solutions that fit their needs,
enabling them to achieve innovation and competitiveness. A deeply multicultural
organization, Capgemini has developed its own way of working, the Collaborative
Business Experience™, and draws on Rightshore®, its worldwide delivery model.
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trademark belonging to Capgemini.
Capgemini is an
Equal Opportunity Employer encouraging diversity in the workplace. All
qualified applicants will receive consideration for employment without regard
to race, national origin, gender identity/expression, age, religion,
disability, sexual orientation, genetics, veteran status, marital status or any
other characteristic protected by law.
This is a general
description of the Duties, Responsibilities and Qualifications required for
this position. Physical, mental, sensory or environmental demands may be
referenced in an attempt to communicate the manner in which this position
traditionally is performed. Whenever necessary to provide individuals with
disabilities an equal employment opportunity, Capgemini will consider
reasonable accommodations that might involve varying job requirements and/or
changing the way this job is performed, provided that such accommodations do
not pose an undue hardship.
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link for more information on your rights as an Applicant:http://www.capgemini.com/resources/equal-employment-opportunity-is-the-law
Work Location: Pensacola, FL
Job Title: Supervisor, Care
Department: Care Management
SUMMARY: The Care Management Supervisor is responsible for
coordinating, monitoring, evaluating, and facilitating high quality, cost
effective care related to medical/care management. Assists in the
development, organization, direction and maintenance of all Care Management
functions for Members/Policyholders. The Supervisor provides oversight in
the day-to-day care management activities and works independently with little
ESSENTIAL DUTIES AND RESPONSIBILITIES include the following. Other
duties may be assigned.
Coordinates care services for
members/policyholders as prescribed by the departments’ policy and medical
necessity of the member/policyholder.Assists in monitoring of member, physician,
and provider satisfaction by overseeing those conducting satisfaction
surveys, documenting, researching, and resolving complaints and forwarding
information to Director of the department.Monitors referrals and care management
activities by adjusting staffing and work assignments as needed to
maintain productivity standards.Maintains appropriate levels of
utilization. Assists in analyzing utilization reports and developing
strategies for operational improvements as needed.Assists in implementation of operational
changes in order to improve efficiency of processes and meet the
department’s strategic goals.Serves as a clinical resource to the care
managers and other non-clinical staffResolves complaints in a positive manner with
tact and diplomacy within established time frames.Continuously monitors status and impact of
care coordination, care management and adjusts plan accordingly.Maintains awareness of federal legislation
effective care management services.Ensures clinical staff complies with
department, carrier, and CHCS policies and procedures.Responsible for orienting, training,
counseling, and terminating staff, when needed.Conduct employee performance evaluations in a
timely manner when needed and forward information to Director.Functions as a facilitator with regard to
workplace departmental issues.Promotes overall organizational and financial
goals as well as improvement in overall quality of the health care as the
primary goal of any initiative.Responsible for the daily management of
appointed staff and work in collaboration with other departments to
achieve outcome goals for member/policyholder health and wellness, chronic
condition, and care management.Interacts with Provider Network Department to
promote coordinated approach and support each department’s initiatives and
communicates consistent messages in all interactions.Monitors and assists in completing reports
that may include but are not limited to identification of utilization
trends, overall quality of the health care of the care managed population,
etc.Responsible for the monitoring of weekly
audits to ascertain that process standards are met and successful outcomes
are achieved.Facilitate care coordination, care management
interaction and problem solving through collaborationSchedule regular team meetings for
communication and feedback, staff training and development, sharing of
program results, and collaborative problem solving.Establishes working relationship with referral
sources.Assesses patient specific information related
to level of function and individual needs.Demonstrates the use of interviewing skills
that include the professional judgment to probe as necessary to uncover
underlying concerns of the client.Plans and establishes treatment goals that
meet client health care needs as identified through the assessment
process.Identifies and implements available,
appropriate and cost effective treatment modalities based on the plan. The
plan is action oriented and time specific.Knows average benchmarks for duration of
services for disease treatment.Communicates case objectives and sets goals
for services providers.Plans and participates in data gathering
procedures.Assesses clinical evaluations and co-ordinates
all aspects of treatment options to meet goals.Identifies high-risk cases and possibility of
complication. Considers and applies principles of human behavior,
family/care giver dynamics, human development and disability into the care
management process.Shares and reports legal and professional
issues pertaining to confidentiality.Acts as an advocate for the individual’s
health care needs.Assesses and addresses specific disease
process issues.Applies regulatory scope of practice to home
care providers.Continuously monitors status and impact of
care management and adjusts plan accordingly.Evaluates the client need for medically
necessary services at intervals, determines the effectiveness in reaching
desired outcome and goals.Modifies the plan of care as indicated.Evaluates the quality of services performed by
providers.Works closely with all identified members of
the team including physician, nurse,
provider, insurer, and client throughout the
process.Evaluates and maintains a satisfactory level
of perceived client satisfaction.Interpret insurance coverage, exclusions and
reimbursement conditions.Utilizes cost containment strategies that
maximize access to funding.Evaluates, negotiates and plans for the cost
of care options.Documents all care management services
rendered.Utilizes planning and goals development
techniques.Maintains awareness of federal legislation
effecting care management services.Establishes client support systems while
utilizing available resources and services.Utilizes appropriate community resources and
services to achieve optimal outcomes while reducing financial exposure.Provide exceptional customer service to all
internal and external contacts.
(A) Demonstrated interviewing skills which include the
professional judgment to probe as necessary to uncover underlying concerns of
(B) Demonstrated ability to establish and maintain empathic
(C) Experience in conducting social and health assessments.
(D) Knowledge of human behavior, family/caregiver dynamics, human
development and disability.
(E) Awareness of community resources and services.
(F) The ability to understand and apply complex
service reimbursement issues.
(G) The ability to evaluate, negotiate and plan for the costs of
-Responsible for assisting Care Managers and Care Contact
Coordinators in problem solving and managing challenging scenarios on a
day-to-day basis. Interacts with supervisor in problem solving activities,
-To perform this job successfully, an individual must be able to
perform each essential duty satisfactorily. The requirements listed below
are representative of the knowledge, skill, and/or ability required.
Reasonable accommodations may be made to enable individuals with disabilities
to perform the essential functions. Basic knowledge of Windows, Excel and
-Care management supervisors shall meet all the qualifications of
a care manager plus have demonstrated supervisory ability, and at least one
year of specific experience in conducting assessments, developing care plans,
and monitoring home and community based services
EDUCATION and/or EXPERIENCE
-Must possess a current RN license in the state of residence.
A minimum of three years relevant nursing experience in clinical experience in
a hospital/facility/home care setting, preferred. A minimum of 3+ year’s
previous supervisory experience that may include Quality Assurance, Utilization
Management, and/or Care/Disease Management. An Associate or Bachelor’s Degree
in nursing, health and gerontology or a related field. Care Management
Supervisor shall have the following additional qualifications: (a)
demonstrates ability to establish and maintain empathetic relationships; (b)
experience in conducting social and health assessments; (c) knowledge of human
behavior, family/caregiver dynamics, human development and disability; (d)
awareness of community resources and services; (e) must demonstrate effective
supervisory ability, and at least one year of specific experience in conducting
assessments, developing care plans, and monitoring home and community-based
services, and (f) computer literacy.
-Ability to read, write and comprehend English. Ability to
analyze, interpret general business periodicals, professional journals,
technical procedures, or governmental regulations. Ability to write
reports, business correspondence, and procedure manuals. Ability to
effectively present information and respond to questions from groups of
managers, clients, customers, and the general public.
-Ability to calculate figures and amounts such as discounts,
interest, commissions, proportions, percentages, area, circumference, and
volume. Ability to apply concepts of basic algebra and geometry.
-Ability to solve practical problems and deal with a variety of
concrete variables in situations where only limited standardization
exists. Ability to interpret a variety of instructions furnished in
written oral, diagram, or schedule form.
CERTIFICATES, LICENSES, REGISTRATIONS
-RN license required.
-BSN degree and/or CCM certification a plus.
-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 may be made to enable individuals with
disabilities to perform the essential functions.
-While performing the duties of this job, the employee is
frequently required to sit; use hands to finger, handle, or feel; and talk or
hear. The employee is occasionally required to stand; walk; reach with
hands and arms; climb or balance; and stoop, kneel, crouch, or crawl. The
employee must occasionally lift and/or move up to 10 pounds. Specific
vision abilities required by this job include close vision, distance vision,
color vision, and ability to adjust focus.
-The work environment characteristics described here are
representative of those an employee encounters while performing the essential
functions of this job. Reasonable accommodations may be made to enable
individuals with disabilities to perform the essential functions.
-Office setting or work from home setting, as determined by