Description
**Job Description:**
Responsible for overseeing the management and optimization of outpatient Care Management activities and evidence based programs. Responsible to develop and maintain CareInMotion, Care Management systems to promote process standardization, end-user functionality, adherence to Health Plan, Model of Care and NCQA requirements while maintaining the ability to effectively monitor program adherence, key metrics, data management and extraction and program effectiveness. Evaluation of program adherence and metric improvement strategies. Accountable for policy, standard operating procedure, training classes and resource development and maintenance. Works in collaboration with Nursing Director of Managed Care/Clinical Operations.
**Full Time Care Management Director- Nevada Medical Group.**
Responsible for overseeing the management and optimization of outpatient Care Management activities and evidence based programs. Responsible to develop and maintain CareInMotion, Care Management systems to promote process standardization, end-user functionality, adherence to Health Plan, Model of Care and NCQA requirements while maintaining the ability to effectively monitor program adherence, key metrics, data management and extraction and program effectiveness. Evaluation of program adherence and metric improvement strategies. Accountable for policy, standard operating procedure, training classes and resource development and maintenance. Works in collaboration with Nursing Director of Managed Care/Clinical Operations.
**EXPERIENCE REQUIREMENTS:**
5 years' experience in clinical setting demonstrating the ability to assess, document and implement the nursing care plan.
5 years' experience in medical management/managed care
5 years' experience with Health Plan requirements, quality, SNP MOC and/or NCQA
5 years' experience with care management documentation systems
Previous management experience
**EDUCATIONAL REQUIREMENTS:**
Graduation from an accredited school of Nursing.
Current state RN license
**KNOWLEDGE, SKILLS, ABILITIES:**
Excellent communication skills and ability to collaborate with, patients, families and providers and interdisciplinary team.
Excellent computer skills utilizing electronic documentation systems, WORD and EXCEL.
Thorough understanding of RN scope of practice.
Valid driver's license, insurance and vehicle for work-related travel.
Ability/experience to effectively orient and mentor new care management teammates.
Proficient in development and ongoing updates for teammate and associated materials.
Experience in participating and/or leading work groups and task forces.
**ESSENTIAL FUNCTIONS:**
Responsible for quality and continuous improvement within the job scope.
Responsible for all actions/responsibilities as described in company controlled documentation for this position.
Contributes to and supports the corporation's quality initiatives by planning, communicating and encouraging team and individual contributions toward the corporation's quality improvement efforts.
Consistently exhibits behavior and communication skills that demonstrate Intermountain Health's commitment to superior customer service, including quality, care and concern with each and every internal and external customer.
Works in collaboration with Clinical operations leadership and teammates to ensure clinical nursing and care management nursing processes, goals and metrics aligned.
Ensure documentation compliance with CM delegated programs and standardization across medical group and affiliate CM programs.
Responsible for electronic documentation system data management, program analysis for case management portions of electronic documentation system.
In collaboration with Decision support: develop and maintain Key Metric reports to include but not limited to, productivity, program adherence, documentation adherence, program and staffing model effectiveness.
Oversee CM/electronic documentation system training, system development and annual competencies.
Works collaboratively with Medical Directors and Physician leadership. Works in synergy with quality department to align strategy and tactics.
Health Plan Liaison.
Creates training classes and online resource materials. Maintains Share Point care management site.
Ensuring Managers are prepared for audit; audit tools, case review, and resources.
Addressing corrective action plans for audits.
Works collaboratively with Clinical Ed department in development and content of clinical teammate education sessions, skills labs and onboarding.
Work with department managers on action items related to education, resources, and processes
Collaborate with System Administrator to maintain and enhance CIM to meet business needs and regulatory requirements.
Works collaboratively with Medical Directors and Physician leadership. Works in synergy with quality department to align strategy and tactics.
Health Plan Liaison.
Creates training classes and online resource materials. Maintains Share Point care management site.
Ensuring Managers are prepared for audit; audit tools, case review, and resources.
Addressing corrective action plans for audits.
Works collaboratively with Clinical Ed department in development and content of clinical teammate education sessions, skills labs and onboarding.
Work with department managers on action items related to education, resources, and processes
Collaborate with System Administrator to maintain and enhance CIM to meet business needs and regulatory requirements.
Collaborate with electronic documentation system vendors and attend all related meetings including regular meetings and annual conferences.
Demonstrates a thorough understanding of medical management and monitors metric and cost reports.
Attends/completes all assigned meetings and educational offerings.
Uses, protects, and discloses patients' protected health information (PHI) only in accordance with Health Insurance Portability and Accountability Act (HIPAA) standards.
Ability to work in a clinic setting and adhere to patient and personnel safety and OSHA requirements.
Participates/leads work groups, task forces, policies and procedure development as assigned.
Ensures documentation in various electronic documentation systems that meet quality and regulatory standards.
Performs additional duties as assigned
**WORKING CONDITIONS**
Working conditions are normal for an office environment
**Physical Requirements:**
**Anticipated job posting close date:**
08/20/2024<
Compensation Information:
$50.22 / Hourly - $50.22 / Hourly
Starting At: 50.22 Hourly
Up To: 77.53 Hourly
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