Elder Services of the Merrimack Valley
  • 12-Jan-2021 to 22-Jan-2021 (EST)
  • Managed Care
  • Lawrence, MA, USA
  • Full Time

Full benefits package available

Elder Services of the Merrimack Valley and North Shore


Position Responsibilities: The Managed Care Program Manager will work as a member of the Managed Care Leadership Team to ensure the smooth operations of the Managed Care Programs within the department. This Manager will participate in the hiring, training, quality assurance and performance evaluations of the Managed Care direct staff and work with assigned Managed Care teams to ensure that all staff, new and experienced, receive adequate training and support to perform basic job functions.


Essential Functions: (Core duties or tasks that is fundamental and not marginal to the performance of the job)


Program Oversight:

  • Hire, train, provide ongoing supervision and QA to the Geriatric Support Services Coordinator (GSSC) utilizing both the ASAP and SCO data bases.

  • Ensure that the unique SCO data entry requirements are completed in the timeframes required by each SCO.

  • Act as the Liaison between ESMV and each SCO to ensure that the GSSC completes contractual requirements, responds to all programmatic inquires and coordinates all requests from the SCOs.

  • Participate in agency performance evaluations with each SCO and resolve practice issues identified.

  • Create systems and maintain written policies and procedures related to the operation of each SCO, conduct audits, reports and other compilations of data pursuant to each SCO requirement.

  • Prepare for, track, and work toward timely and accurate admissions and discharges to each SCO program.

  • Ensure accurate and timely documentation across all SCO and ESMV systems.

  • Act as the Liaison between ESMV Home Care staff and SCO to ensure cooperation and timely exchange of information regarding enrollees known to both.

  • Attend local and statewide meetings with SCO for training, system updates and collaboration.

  • As a member of the Managed Care Manager Team, work closely with Managed Care Management to develop and implement new Quality Assurance initiatives that apply to GSSCs.

  • Maintain existing Quality Assurance systems in SCO including case file auditing for Annual Performance Reviews and programmatic audits as needed.

  • Other duties as assigned.


Management of Managed Care Team - Provisional Employees:

  • Coordinate and participate in the new staff hiring and orientation processes for SCO.

  • Provide weekly one-on-one Coaching to review all case documentation for accuracy and compliance with SCO and ESMV standards and to discuss clinical issues.

  • Track home visits and monitor progress of new referrals through case review and software tracking methods to ensure compliance and provide training on managing the pace of the work.

  • Maintain open communication with the Team Facilitator/ Mentor of employees on Provisional Employment status to gather feedback on the new employee's progress and discuss timelines for the new employee to assume additional team responsibilities.

  • Work in coordination with Team Facilitator/Mentor to complete the new employee's six month Progress Report and make recommendations to the Managed Care Director regarding regular employment status and termination of coaching period.


Management of Managed Care Team - Experienced Direct Service Staff:

  • Provide scheduled one-on-one supervision to review compliance with SCO and ESMV standards, provide support, and to discuss clinical issues.

  • Complete annual performance evaluations of GSSC SCO staff including conducting case audits, compiling annual QA data, summarizing Team Feedback, completing Manager's Summary, setting goals, assessing for Merit increases and conducting evaluation meeting with employee.

  • Meet with experienced employees for remedial Coaching and training relative to areas identified through agency Quality Assurance efforts as required.

  • Participate in Progressive Discipline process as indicated.

  • Promoting professional development and participate in agency staff recognition programs.



  • Participate in rotation of Manager of the Day departmental coverage responsibilities.

  • Manage caseload coverage and redistribution as needed within SCO program.

  • Serve as Team Manager for assigned teams including attending team meetings bi-weekly at minimum and work with teams around conflicts, coverage and other issues that arise.

  • May assist in programs or special projects related to coaching, training, quality and customer service as required.


Qualifications: BA/BS in social work, human services or related field as well as significant related experience required. Experience in agency direct service (i.e. comprehensive knowledge of Agency systems, programs and SAMS) required. Knowledge and experience in the following preferred:  Quality Assurance and Quality Improvement systems and processes; data collection and analysis. Knowledge of Managed Care and/or other healthcare delivery system as well as experience managing large programs is critical. Excellent interpersonal, verbal and written communication, supervisory and computer skills required.


Hours: 37.5 per week



Elder Services of the Merrimack Valley
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