Lead Care Manager

Emploi pas sur LinkedIn

🕒 il y a 8 jours

Postuler Maintenant

Trouver des Emplois à Distance Similaires

Recevoir des emails pour des emplois à distance

📊 Vérifiez votre score de CV pour ce poste

Améliorez vos chances d'obtenir un entretien en vérifiant votre score de CV avant de postuler.

Télécharger le CV

WVU Medicine

Site WebLinkedInTous les Emplois

10 000+ employés

⚕️ Assurance santé

Healthcare Insurance

WVU Medicine est un système de santé complet affilié à l'Université de Virginie-Occidentale, offrant des services médicaux via un réseau d'hôpitaux à travers la Virginie-Occidentale. Ce système comprend des établissements notables tels que le J. W. Ruby Memorial Hospital, WVU Medicine Children's, et divers autres centres médicaux régionaux. WVU Medicine propose une vaste gamme de services de santé, incluant des traitements médicaux spécialisés et avancés comme la chirurgie cardiaque robotisée. Il est également impliqué dans l'éducation médicale, la recherche et les initiatives de santé communautaire, mettant l'accent sur une mission de fournir des soins de haute qualité aux communautés qu'il dessert.

Description

• 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

🎯 Exigences

• 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

🏖️ Avantages

• Some travel may be required to offsite meetings