Description
Evernorth Care Group (ENCG) is a leader in integrated primary care and an industry pioneer in value-based care. We focus on providing high-quality, affordable and accessible care for our patients across Arizona.
The Care Management team works closely with the primary care team to support patients through their healthcare journey. The team works hand in hand with primary care providers to ensure the patient is cared for beyond the clinic walls. This position is a key partner implementing population health and care management capabilities across a network of primary care medical clinics. The goal of this work is to make care more affordable for ENCG's patient population through the execution of best practice clinical programs that provide patient-centered care and improve the overall health of the patient population.
Through oversight, influence, and relationship-building, this role will ensure the implementation of consistent practices, processes, and protocols to achieve excellence in quality of care, service, resource utilization, employee/physician satisfaction, and workplace safety. This position will utilize data, sound operational processes, and shared goals to improve the performance of the care group and will effectively collaborate with Care Delivery and external partners.
The Care Management Manager executes initiatives for the Care Management team to improve operational effectiveness and financial outcomes. This position will oversee licensed and non-licensed staff working with vulnerable populations and offering holistic care management, care coordination, and disease management support to customers and physician practices located throughout the Phoenix metro area.
Critical to this position is the ability to promote an innovative and inclusive culture, with a primary focus on enabling support staff to embrace the ENCG strategy of promoting quality care and providing efficient services in a customer centric manner. Additionally, this position collaborates with the Quality Clinical Program Senior Manager to ensure all requirements of value-based and core contracts are met through the implementation of population health-based initiatives and programs.
**Hours:** Monday - Friday 8am - 5pm (flexibility with exact hours) Must live in Arizona
**Reports to** **:** Clinical Program Director
**Direct Reports** **:** Care Management RNs, Care Navigators and Social Workers
**Responsibilities and Essential Functions**
Accountable for directing case management activities and developing strategies to control the costs of high-risk, high-cost cases by mitigating hospital admissions, readmits, ED utilization and working closely with clinicians to meet MLR, ADK and EDK metrics.
Identify cost-effective protocols and initiatives for high-risk, high-cost diagnoses; and, developing and administering guidelines for working with employees, employers, policyholders, healthcare providers, patients, and families to determine appropriate, cost-effective care plans.
-Ensures- quality patient care by Care Management staff through transitional care management, care planning, chronic disease management, targeted outreach initiatives, and connections to community resources.
Responsible for the strategic and operational leadership of ENCG Population Health efforts. This role will partner with VBC lead to create and execute on strategy to deliver on care co-ordination performance metrics on VBC contracts. Collaborate as a thought leader in developing and/or improving clinical strategy that enables stronger coordination of care, affordability, customer/clinician experience and transparency.
Ensures the Care Management team coordinates care between the primary care physician, community resources, family and patient.
Provides direct and remote oversight of staff and assures achievement of individual and team performance and productivity standards; monitors work product and division of work between team members to promote staff working at the top of their licensure.
Monitors and analyzes routine and ad hoc reports, case loads, and care coordination management efforts for the team; routinely rounds on staff to communicate key messages and identify concerns and issues.
Manage and execute Care Management programs (Transitions of Care, Chronic Disease Management - such as diabetes); ensure consistent, efficient and cost-effective processes, procedures and appropriate accountability.
Participates in joint operating committee meetings with health plans. Meets value-based contract metrics and outcomes as determined by ENCG contracted health plans, CMS, State of Arizona (AHCCCS) and contractual obligations for commercial customers.
Partner with clinical and operational leadership to align initiatives and prioritize interventions for greatest impact; properly utilize technology to standardize assessments, workflows, and care planning to build initiatives to scale.
Drive the development and practice implementation of population health initiatives and continue optimizing as needed to achieve the desired clinical and business outcomes.
Facilitate dissemination of best practices and development of new tools to support standardization of roles and more effective outputs.
Directly responsible for personnel actions including hiring, training, coaching, evaluating performance, monitoring time and attendance, and scheduling of team members.
Provide constructive feedback and effectively manage conflict within the Care Management team. Ensure patient and provider satisfaction with Care Management services and demonstrates service recovery when needed.
Promotes effective communication between Care Management and other ENCG departments and entities, acting as a liaison to facilitate information sharing, collaborative problem solving and adequate provision of services; fosters and maintains collaborative relationships within the clinician practices, hospitals and external agencies related to quality performance and day-to-day issues that may arise.
Leads the team effectively through change; regularly and proactively communicating with team leads and staff regarding impending external and internal change. Include other impacted staff whenever possible in designing solutions to effectively navigate change.
Perform all other duties and special projects as needed to support the overarching goals of the Care Management team and/or key business unit partners.
**Skills & Competencies**
Clinical expertise with a mindset and focus on achieving results with and through others
A talent for balancing critical thinking with hands-on execution to successfully implement strategies within team to accomplish organizational goals
The ability to validate data directly tied to population health and
Compensation Information:
$0.0 / - $0.0 /
Starting At: 0.0
Up To: 0.0
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