Manager of Clinical Care Services
Company Background
HealthMap Solutions is the future of specialty health management, that focuses on progressive diseases, with a particular expertise in kidney health populations. HealthMap uses clinical big data resources and high-powered analytics to power complex specialty health management programs. HealthMap Solutions is a diverse, growing company committed to our clients and our employees. We are champions for better health, for those who need us most.
Position Summary
The Manager of Clinical Care Services will be responsible for the management and development of high performing engaged teams. This position will communicate plans and strategy to meet key objectives with internal partners and reports, identify best practices to improve outcomes, and maintain compliance with policies, procedures, and implementation at the employee level. The Manager of Clinical Care Services will be accountable for meeting the financial, operational, and quality objectives of the organization. This role requires strong leadership skills with the ability to multi-task and pivot between projects as needed.
Responsibilities
• Provide strong leadership, direction and accountability for multidisciplinary Care Services operational teams
• Demonstrate a clear understanding of metrics and the ability to extract them. Proven success in analyzing and utilizing metrics to drive successful decisions and outcomes.
• Ability to pivot the program as needed based on the analysis of metrics and strategic business needs
• Ability to learn and master technology systems in order to train and monitor the team and business outcomes
• Resourcing, line management, training, functional delivery and input on discussions around quality and operational delivery measurements within Care Services in agreement with regulatory and accreditation standards (e.g. NCQA)
• Conduct regular discussions with direct reports and lead team meetings
• Conduct regular leadership meetings to provide timely and relevant updates
• Train Supervisors and Associates as required
• Contact for operational questions and escalations
• Work with Director, Clinical Programs and Clinical Quality to communicate all critical issues, business growth opportunities, develop key relationships as well as provide input regarding budgeting discussions to drive productivity and quality
• Drive overall delivery for execution of service, client satisfaction, quality and efficiencies
• Represent HealthMap Solutions Care Services at Sponsor and internal audits
• Collaborate and provide feedback on the development and implementation of training tools and presentations
• Implement agreed corrective actions and/or further training as required
• Conduct performance reviews
• Ensures and sets clear goals and objectives are communicated to teams
• Develop succession planning pathways
• Assist with continuous review of current processes, implementation of process improvements in collaboration with other departments
• Ensure Care Services teams meet performance and quality objectives
• Review Care Services policies, procedures and desk level procedures
• Participate in business development activities
• Participate in recruitment and hiring activities
• Model and drive change
• Requires HIPAA understanding and complete confidentiality protocols
• Associate must demonstrate understanding and sign confidentiality documents
• Employee is expected to comply with HIPAA privacy laws and all other federal, state, and local regulations
• Report suspected or detected security events via company provided communication channels
• Follow all company-defined operational policies and procedures
• Protect and maintain confidentiality of company and customer information, policies, and processes
• Perform other related duties as assigned
Requirements
• Bachelor’s degree is required
• Active RN license is required
• 7 years of Strong Leadership experience required
• 3 years of experience in a managed healthcare environment required
• Familiarity with NCQA, HEDIS and STARS requirements strongly preferred
• Per HealthMap’s HR Security Policy, this position is considered HY (high risk for PHI and may require additional training/screening)
Skills
• Excellent verbal, communication, negotiation, and presentation skills
• Dedicated hardworking employee who achieves maximum efficiency and productivity
• Proven ability to manage multiple projects and lead large teams
• Must be proficient in Microsoft Office: Outlook, Word, Excel, PowerPoint
Care Navigator – RN
Company Background
HealthMap Solutions is the future of specialty health management, that focuses on progressive diseases, with a particular expertise in kidney health populations. HealthMap uses clinical big data resources and high-powered analytics to power complex specialty health management programs. HealthMap Solutions is a diverse, growing company committed to our clients and our employees. We are champions for better health, for those who need us most.
Position Summary
The Care Navigator will be responsible for assisting in care coordination and case management duties for all identified patients, specific to kidney health management. The Care Navigator will be available to assist incoming callers in a call queue environment. Daily activities will include maintaining individual metrics, engagement of members into the Care Navigation program, managing a set case load of mixed acuity members, review and/or obtain member data, data entry in HealthMap’s Care Management documentation system, completing HRA’s, assessments, member centric care plans, updates of identified problems, barriers, interventions and goals, patient teaching and assistance with ongoing case management. The Care Navigator will notify the providers of changes in patient status, medications, patient level of care, new problem identification and updates to the care plan. The Care Navigator will collaborate with the Care Coordinator regarding appointment setting, scheduling, mailings and care plan coordination needs. The Care Navigator will collaborate with internal as well as external (physicians, nurses, and other healthcare personnel) to assure positive patient outcomes and care coordination. Care Navigator will participate in all care navigation rounds. Care Navigator will identify success stories, specific to Renal Replacement Therapies (RRT), Dialysis, and Renal Transplant as directed.
Responsibilities
• Accountability for individual metrics
• Availability in a call queue environment
• Support afterhours, weekends, and various time zones based on business need
• Engage members into HealthMap’s Kidney Health Program
• Management of member centric care plan, problems, barriers, interventions, and goals as appropriate
• Follow up with members based on complexity and cadence by policy
• Act as the patient advocate responding to and working to resolve patient concerns or barriers
• Performs Care Plan updates and monitoring to develop and assure patient compliance with physician’s orders and care management
• Serves as a resource to patients and physicians. Familiarity with community resources and programs and utilizes in care planning
• Provides Care Navigator activities for the continuum of care to facilitate and promote high quality, cost effective outcomes for patients and focusing on the whole patient and care delivery coordination
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• Act as a liaison between the patient, the patient’s support network, treating physician, and other ancillary providers as a member of an interdisciplinary care team to coordinate care, resolve nursing problems and assist patients in meeting individualized goals
• Acts as a preceptor, mentor, and coach for new hire orientees
• Notify Providers of changes in patient status, patient level of care, new problem identification and the need for additions the care plan
• Collaborates with the BH Social Worker as appropriate
• Attend Kidney Health Management Care Management Rounds as appropriate
• Review and monitor physician practice medical record for changes in patient condition, new or changed doctors’ orders, medication changes, and lab values specific for Kidney Health Management
• Demonstrated HIPAA understanding and complete confidentiality protocols:
• Demonstrate understanding and sign confidentiality documents
• Employee is expected to comply with HIPAA privacy laws and all other federal, state, and local regulations
• Comply with company security policies
• Follow all company-defined operational policies and procedures
• Uses multiple technical applications including word, excel spreadsheets, electronic calendars, email and other software applications
• Monitors and manages key performance indicators as identified by the organization level and department level
• Builds strong cross-functional relationships with internal departments as well as physician partners and practice staff
• Use approaches, services, and tools to engage patients and their families in their own care and to support self-management
• Perform evaluation of each patient periodically, and at critical junctures for measurable differences in Clinical, Financial, Quality of Life and Satisfaction categories
• Document and maintain accurate correspondence logs that will identify all patient communication and plans
• Performs other related duties as assigned
Requirements
• Registered Nurse
• BSN preferred
• Certification in Case Management preferred
• Bilingual Preferred
• 3 or more years of experience in case management
• Experience in a dialysis center, or transplant center preferred
• Experience in customer service strongly preferred
Skills
• Demonstrated Organizational skills
• Demonstrated Knowledge of Case Management and Managed Care
• Strong Motivational Interviewing Technique
• Strong Communication skills
• Knowledge of Medicare, Medicaid preferred
• Ability to work in a fast-paced environment with changing priorities
• Problem solving capabilities
• Must be proficient in Microsoft Office: Outlook, Word, Excel, PowerPoint
Job Type: Full-time
Visit: www.healthmapsolutions.com
