Value Based Clinical Care Team Manager

Position Overview

You will play a crucial role in overseeing the daily operations of a collaborative, multi-disciplinary clinical and support team focused on advancing Value Based clinical initiatives. Your responsibilities will include case management, transitions of care, care coordination, and staff education on ACO/MA Plan clinical programs. You will also cultivate and maintain a network of community support.

What You'll Be Doing

• Manage Clinical Programs: Oversee daily operations of ACO/MA Plan Clinical Programs to enhance clinical efficiencies and improve patient care.
• Optimize Utilization: Identify opportunities to shift care from inpatient to outpatient settings to better serve our patients.
• Population Health Management: Utilize data to assess and manage the health needs of our population, implementing programs for ACO/MA Plan beneficiaries.
• Case Management: Provide case management for high-risk patients to reduce unnecessary emergency department visits and hospitalizations.
• Lead the Patient Care Team: Supervise a dedicated team including Social Workers, Emergency Department Liaisons, Behavioral Health Liaisons, and Home Health Liaisons.
• Transition of Care: Ensure smooth Transitional Care Management for patients discharged from inpatient facilities, coordinating visits with primary care providers, DME, Home Health Services, and community resources.
• Quality Assurance: Review and address Quality Measures to ensure compliance and improve outcomes.
• Health Education Activities: Develop and direct health education initiatives for beneficiaries, providers, and staff.
• Collaborate in Meetings: Participate in Care Coordination and Quality Committees, Primary Care Provider Meetings, and other relevant discussions.
• Monitor Corporate Strategies: Keep track of corporate initiatives to align with business and financial goals.
• Integration of ACO Programs: Manage the integration of ACO Programs into existing operations to meet the needs of all stakeholders.
• Build Relationships: Maintain strong collaborative relationships with both internal teams and community partners.
• Implement Organizational Changes: Manage and execute organizational opportunities and changes that align with corporate financial goals and strategic endeavors.
  
  

Qualifications

• RN/BSN required.
• Minimum of 4 years of clinical nursing experience.
• At least 4 years of extensive experience in chronic care case management in an outpatient setting.
• Certification in case management preferred.
• Ability to work remotely from Georgia, Pennsylvania, or Texas.
• Comfortable leading a team of certified but unlicensed personnel and Registered Nurse case managers.
• Strong analytical skills to read, analyze, and interpret complex documents and respond effectively to sensitive inquiries.
  
  

Certificates, Licenses, Registrations

• Registered Nurse preferred.
  
  

Benefits

• Work from Home: Enjoy the flexibility of a fully remote position.
• Health Benefits: Comprehensive Medical, Dental, and Vision plans.
• 401(k) Plan: A 3% employer match to your 6% contribution.
• Life and Disability Insurance: Peace of mind insurance options.
• Employee Assistance Program (EAP): Access support during challenging times.
• Flexible Time Off: Tailored to achieve work-life balance and personal goals.
• Parental Leave: Paid parental leave to support significant life changes.
• Professional Development: Resources dedicated to your learning and career advancement.
  
  

Compensation

The listed compensation range is bi-weekly, with final pay depending on factors like skill set, experience, education, location, and certifications.

Commitment to Equal Opportunity Employment

We embrace diversity, inclusion, and belonging in our workplace. We make employment decisions without regard to race, religion, color, age, sex, sexual orientation, national origin, disability, or any other classification protected by law.

Commitment to Data Protection

This position requires adherence to all security policies and procedures to protect PHI and PII under our custodianship.

Employment Type: Full-Time