This position oversees operational activities of the Care Management area of the Medical Management department. This includes program development and monitoring, staff development including overseeing frontline supervisors. This position assists in developing and operationalizing new programs and ensures regulatory and contractual requirements are met.
Duties and Responsibilities
Responsibilities include, but are not limited to the following:
Develops, executes and evaluates work plan for area of responsibility
Ensures ongoing monitoring, evaluation, and outcome measurement for all Case Management (CM) programs
Provides regular reports and presentations on clinical outcomes of CM programs
Identifies opportunities and cost/benefit for new CM programs and enhancements to existing programs, using data analysis tool
Assists with developing case management programs for new lines of business
Provides supervision, direction and guidance to team while serving as the subject matter expert and lead on functional deliverables
Provides performance feedback and coaching to staff, as well as makes hiring and termination decisions
Assist in the training of new staff and providing an environment of continuous learning for existing staff
Sets performance standards and productivity measures for direct reports
Professional development of staff, including identification of educational opportunities, annual performance appraisals and goal development
Determines/monitors staffing ratios
Develops and ensures consistency in CM documentation standards
Works with Clinical Trainers in the development of comprehensive role specific orientation/training programs
Manages the development of CM policies and procedures and ensures annual review and revision
Collaborate with Chief Medical Officer and Medical Director on new and existing clinical programs
Serves as organizational consultant for CM performance practice
Participates in administrative budget development and monitoring for area of responsibility
Identifies and recommends opportunities for improvement and implements process improvement activities
Representative of CM programs with state and community partners
Collaborate with Matrix partners to develop, maintain and evaluate programs
Other duties as assigned
Numbers & Facts
Location
Smithfield, RI
Industry
Healthcare Services
Company Size
100 to 499 employees
Website
https://www.nhpri.org/
About Company
Neighborhood's employees come from a diverse background but all are committed to creating a more equitable health care system. Our array of experiences allows us to have a broad perspective and great creativity in facing whatever challenges arise. Unlike many other health insurance companies, we have nearly 30 nurses and social workers on staff. This structure speaks to our focus on active and compassionate care management for our members; we know that people who are alienated from the health care system require additional advocacy, outreach and support.
Neighborhood offers an exceptional compensation package to employees. We annually review base salaries/benefits and adjust as appropriate.
Skills
Budget Managementunmatched
Case Managementunmatched
Clinical Outcomesunmatched
Coachingunmatched
Consultingunmatched
Contract Requirementsunmatched
Data Analysisunmatched
Documentation Standardsunmatched
Performance Goal Settingunmatched
Performance Reviewsunmatched
Policy Developmentunmatched
Procedure Developmentunmatched
Process Improvementunmatched
Program Evaluationunmatched
Project Planningunmatched
Regulationsunmatched
Reporting Skillsunmatched
Staff Developmentunmatched
Staff Trainingunmatched
Training Programunmatched
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