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Mgr., of Case Management and Disease Management

1 month ago

Dallas, Texas, United States Parkland Health and Hospital System Full time

Interested in a career with both meaning and growth? Whether your abilities are in direct patient care or one of the many other areas of healthcare administration and support, everyone at Parkland works together to fulfill our mission: the health and well-being of individuals and communities entrusted to our care. By joining Parkland, you become part of a diverse healthcare legacy that's served our community for more than 125 years. Put your skills to work with us, seek opportunities to learn and join a talented team where patient care is more than a job. It's our passion.

Primary Purpose

Parkland Community Health Plan's (PCHP's) Manager, Disease Management is responsible for the oversight of the disease management activities within the department. This role is responsible for ensuring adequate staffing exist to meet the quality and productivity standards in support of the regulatory standards and guidelines. The manager may or may not be a clinician, depending on the skillset of their assigned team.

Minimum Specifications

Education

  • Associate degree in nursing, Social Work, Healthcare Administration or Public Health or other health related field
  • Master's degree in nursing, social work, Healthcare Administration or Public Health or other health related field Preferred

Experience

  • Minimum 4 years of experience working in a relevant condition management area such as asthma, diabetes.
  • Five years of experience in managed care or disease condition management is preferred.
  • Experience in Medicaid and NCQA disease management is preferred.
  • Experience with federal, state, and /or local statues, guidelines, and audits is preferred.

Equivalent Education and/or Experience

  • May have equivalent combination of education and /or experience in lieu of education.

Certification/Registration/Licensure

  • Must have current, unrestricted license to practice Nursing, or Social Work in the state of Texas (or compact license).

Skills or Special Abilities

  • Proficient in medical and managed care terminology
  • Clear and professional verbal and written communication skills
  • Proficient in Microsoft word, excel, and power point, condition management software.
  • InterQual experience is preferred.
  • Ability to be flexible and organized in a rapidly changing environment.
  • Aptitude for interpreting reports and using spreadsheet functions, such as formulas, graphs, and formatting.
  • Ability to analyze and resolve complex and conflicting information.
  • Able to manage multiple deadlines and time constraints.
  • Proficient in meeting NCQA condition management standards
  • Knowledge of Federal and Texas Medicaid regulations
  • Ability to define reporting requirements.

Responsibilities

  • Oversees the development and maintenance of the disease management program by auditing and enforcing health plan policies.
  • Collaboratively assist with achieving and maintaining NCQA accreditation
  • Compiles and reviews multiple reports for statistical and financial tracking purposes to identify trends and assist with financial forecasting.
  • Manages the disease management teams day to day operations, scheduling time off approvals, communication and performance evaluations while supervising, motivating and guiding staff.
  • Assist in the development and updating of the disease management program description, work plan and annual evaluation.
  • Participates in interdisciplinary team meetings to address resources, barriers, successes and area of improvement with other service coordination team members.
  • Participates in the development and review of content for training plans in conjunction with the departmental trainer to address staff training needs.
  • Prepares audits and improvement plans for deficiencies.

Job Accountabilities

  1. Identifies and analyzes the design of jobs, work processes, workflows, etc. for the area and implements appropriate changes to improve effectiveness, productivity, and efficiency that support the overall goals of PCHP.
  2. Stays abreast of the latest developments, advancements, and trends in the field by attending seminars/workshops, reading professional journals, actively participating in professional organizations, and/or maintaining certification or licensure. Integrates knowledge gained into current work practices.
  3. Maintains knowledge of applicable rules, regulations, policies, laws, and guidelines that impact the area. Develops effective internal controls designed to promote adherence with applicable laws, accreditation agency requirements, and customer requirements. Seeks advice and guidance as needed to ensure proper understanding.
  4. Develops and monitors annual budgets that ensure the department has the necessary funds to carry out the goals and objectives that have been established for the department.
  5. Develops, implements, monitors, and revises annual goals and objectives for the department that support the missions and objectives of PCHP.
  6. Selects, trains, schedules, motivates, supervises, and evaluates employees making recommendations for disciplinary actions up to and including termination, to ensure maximum utilization of individual and group capabilities. Ensures that assigned employees receive opportunities to further their knowledge.

Parkland Health and Hospital System prohibits discrimination based on age (40 or over), race, color, religion, sex (including pregnancy), sexual orientation, gender identity, gender expression, genetic information, disability, national origin, marital status, political belief, or veteran status. As part of our commitment to our patients and employees' wellness, Parkland Health is a tobacco and smoke-free campus.