Job Description

• This role will involve up to 40% Travel across AbsoluteCare locations
• RN license preferred.
• Certification in Case Management (CCM), Utilization Review Accreditation Commission (URAC), or related credentials is a plus.

Job Summary

This role is highly focused on programmatic development around coordination of care, population health, application of data in developing targeted disease and utilization management programs, with focus on quality metrics, outcomes and overall impact on utilization. This role is a key member of our unique multi-disciplinary team working in direct collaboration with other medical professionals, to help patients, become healthier and lower their unnecessary medical utilization. Our program is focused on the whole care continuum including helping navigate different transitions of care.

Duties and Responsibilities

• Further develop care management program standards, practices, protocols, policies, and procedures, in accordance with applicable laws, regulatory and accreditation requirements that are consistent with current research findings, best practices, and national professional standards to achieve excellence in patient care.
• Ensure high quality and timely delivery of care coordination, incorporating NCQA standards.
• Plan and direct operations for all care management staff, including professional development across multiple states and locations, including local managers and their teams.
• Manage staff recruitment, screening, hiring, orienting, and training for the care management team.
• Provide support to ensure superior levels of customer service to our members.
• Act as a liaison between the executive team and the care delivery teams, including clinical and financial components of the organization, in this outcome-based care model.
• Collaborate with our multi-disciplinary team to further program development, evaluate and compare effectiveness of new strategies across the organization.
• Direct and coordinate internal and external agents to maintain patient safety, compliance with applicable standards, and patient rights.
• Plan and supervise administrative aspects of the department, delivery of services, disease management programs, and long-term planning to ensure adequate staffing, resources, and system support.
• Work with the data analyst team to improve reporting and monitoring member engagement and outcomes.
• Monitor and identify barriers within the organization related to successful patient and/or organizational goals.
• Provide training within the organization for other departments within the organization.
• Oversight and management of NCQA Complex Care Management program.

Minimum Qualifications

• Master’s Level Degree.
• Nursing degree and past experience in critical care or at a minimal direct patient care is strongly preferred.
• Minimum of 5 years’ experience in directing case management programs and associated teams for moderate to large organization.
• Experience with NCQA Complex Care Management strongly preferred.
• Experience working with psychosocially and medically complex patients.
• Experience program development and case management software programs.
• Must be able to work as part of a multidisciplinary team with constant collaboration within and across provider teams.
• Ability to exercise independent judgment.
• Skills in planning and organizing nursing and case management programs.
• Ability to multi-task and demonstrate flexibility.
• Enjoy a collaborative opportunity and willing to engage staff in program development.
• Innovative and creative and innovative self-starter to help solve patient's problems.
• Meet deadlines and manage multiple priorities.
• Knowledge and experience using case management software systems and/or EMR systems, with an ability to analyze and leverage their reporting capabilities is a significant advantage.
• Working knowledge of Microsoft Office Suite (Word, Outlook, PowerPoint, and Excel); and
• Ability to travel.

Working conditions

This job operates in a professional office environment. This role routinely uses general office equipment.

Physical requirements

• Ability to communicate clearly and exchange accurate information constantly.
• Ability to remain stationary for long periods of time.
• Repetitious movements.
• Constantly operates computer, keyboard, copy and fax machine, phone, and other general office equipment.

Direct reports

Care Management Program Manager, Program Manager, Utilization Manager, Clinical Educator