Lead Care Manager – PEAK

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Peak Health

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51 - 200 Mitarbeiter

⚕️ Krankenversicherung

🤝 Non-Profit

Healthcare Insurance • Non-profit

Peak Health ist ein Krankenversicherer und Anbieter von Krankenversicherungsdiensten mit Sitz in Morgantown, West Virginia. Das Unternehmen befindet sich im Besitz von drei gemeinnützigen Gesundheitsdienstleistern: WVU Health System, Marshall Health Network und Valley Health. Peak Health hat das Ziel, die Gesundheit der Gemeinschaft zu verbessern, indem es einen inklusiven, anbietergeführten Gesundheitsplan für die Einwohner von West Virginia und die umliegenden Regionen anbietet. Das Unternehmen ist bestrebt, die Gesundheitsversorgung zugänglicher, verständlicher und kooperativer zu gestalten, mit dem Fokus darauf, Kosten und Verwaltungsgebühren für Patienten und Arbeitgeber zu senken. Peak Health bietet außerdem maßgeschneiderte Medicare Advantage-Pläne für Senioren in West Virginia durch Partnerschaften mit führenden Gesundheitssystemen an.

Beschreibung

• Onboarding new employees and mentoring members of the SNP care management team • Providing education, performing documentation audits, and building clinical team members expertise through direct feedback and real-time coaching • Participate in activities related to care management program build, implementation, oversight, and delegation • Assist in ensuring compliance with CMS SNP Model of Care (MOC) expectations, NCQA standards, and Medicare Advantage regulatory requirements • Assists in the development and implementation of policies and procedures related to the Care Management process • Assists with monitoring performance standards, productivity and ensuring staff coverage to meet the needs of the department • Formulates, implements and evaluates educational strategies for staff • Maintains a working knowledge of the requirements of regulatory and compliance entities • Mentors new Care Managers and assists with training • Provides support and coaching to Care Managers and other clinical team members • Perform data collection and analysis of trends to determine areas of opportunity and strategies for better practices for the Care Management team • Takes escalated calls or fills-in for the Care Manager team during high-peak periods • Assist in quarterly reporting of delegated case management processes to meet accreditation standards • Assist in submission of required documents/policies during application process to accrediting body • Provides clinical, procedural or interpretational assistance • Ability to present complex ideas and data to a wide variety of stakeholders from frontline employees to executive c-suite • Establishes and maintains cooperative and positive working relationships with key stakeholders across the organization • Participates in the Interdisciplinary Care Team (ICT) in conjunction with the SNP CM team, PCP and beneficiary/caregiver • Assists in using Peak Health’s analytics tools to monitor HRA timeliness, care plan compliance, ICT effectiveness, utilization trends, and quality outcomes • Serve as a key liaison between SNP Care Management, Peak Health providers, pharmacy, behavioral health partners, and community agencies • Support escalation and review of high-risk, high-need member cases to ensure appropriate interventions, community resource connections, and care plan adjustments • Assist Peak’s Quality Management and Compliance teams to support Stars improvement, HEDIS performance, utilization management coordination, and audit readiness • Support escalation and review of high-risk, high-need member cases to ensure appropriate interventions, community resource connections, and care plan adjustments

🎯 Anforderungen

• Current Registered Nurse license issued by the state in which services will be provided or current multi-state Registered Nurse license through the enhanced Nurse Licensure Compact (eNLC) • Five (5) years of healthcare clinical experience • Two (2) years’ Care Management, Case Management or Population Health experience • Bachelor's Degree in Nursing OR Associate of Science in Nursing Degree (ASN) or Diploma • Management of Medicare and/or Medicaid and/or SNP populations • One (1) year SNP Care Management experience

🏖️ Vorteile

• Health insurance • Paid time off • Flexible work arrangements • Professional development opportunities