Job Description

Position Summary:

The Senior Manager, High Acuity Team will be responsible for driving exceptional performance outcomes by fostering a collaborative experience amongst internal and external stakeholders. The role will provide directional oversight to established plans and make adjustments that account for other Multidisciplinary Care Service teams ensuring nationwide alignment. The position will guide and drive the administrative, clinical, and quality activities related to building strong provider and member engagement and health outcomes.

Responsibilities:

• Develop and facilitate programs to drive clinical enhancements and a positive team culture
• Adjust expectations to meet organizational goals and targets to ensure continuous alignment with mission, vision and values. Reallocating resources to drive accountability where appropriate
• Prove to be an exemplary provider to the value-based care team by adjusting team behaviors to accomplish growth targets within the organization
• Partner effectively with key stakeholders within operations, sales, data analytics, quality and compliance to improve metrics
• Function as ambassador for organization with all internal and external customers
• Collaborate as needed with team to help engage providers and members and serve as escalation point for difficult practices and/or members.
• Implement organization policies, procedures, workflows, and action plans to drive team performance.
• Ensure collaboration and communication among multi-disciplinary teams to ensure they are coordinated in working towards maximum customer engagement and improved member outcomes
• Develop, monitor, and report on team performance and productivity
• Troubleshoot technical issues within operating systems as identified by team members and establish protocols to correct as appropriate
• Promote an environment of continuous improvement through on-going team audits. Work to develop ongoing team education to address areas of opportunity
• Develop, coach, and mentor team members to achieve company, department, and individual goals
• Conduct regular performance evaluations and provide constructive feedback to redirect team members with a positive discipline approach
• Maintain team performance according to National Committee for Quality Assurance (NCQA) standards including but not limited to appropriate provider and member documentation.
• Comply with HIPAA privacy laws, all other federal and local regulations, and company security policies
• Provide recommendations to the leadership regarding necessary operational adjustments needed to ensure organizational objectives and goals are met
• Perform other related duties as assigned

Requirements:

• Bachelor’s degree in healthcare or related field required; master’s degree preferred
• Active, unrestricted RN license required
• Certified Case Manager (CCM) preferred
• Prior experience building and managing relationships with health care providers or patients preferred
• Minimum 5 years progressive supervisory and/or management experience required
• 7 years of experience in healthcare services, clinical operations, quality, or care and utilization management required
• Prior experience managing large data sets, demonstrated sales excellence and managing relationships with health care providers or patients
• Proof of valid and unrestricted driver’s license required
• Must be able to successfully comply with the credentialing process

Skills:

• Excellent verbal, written and presentation skills
• People skills to develop and maintain strong internal and external relationships
• Ability to multitask, prioritize, and create solutions in a challenging environment
• Demonstrated leadership skills and ability to create and maintain a positive work environment
• Strong critical thinking and analytical skills
• Ability to foster strong employee engagement among the team
• Must be proficient in Microsoft Office: Outlook, Word, Excel, PowerPoint

Travel:

Moderate Travel, less than 50%

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