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RN Care Manager
4 months ago
eternalHealth – Your Forever Partner in Healthcare and Beyond
Healthcare is confusing, but it doesn’t need to be. A consumer-centric HMO based in Boston, MA, we are a tech-focused start up that is committed to creating long-lasting partnerships with our members, our providers, and you
About the role: As a RN Clinical Operations Manager with eternalHealth you will be a core member at eternalHealth – whose responsibilities will include care management. This position will work towards meeting financial and operational performance goals and standards.
We provide a unique opportunity to be a part of a health plan in its beginning stages, and you will have insight into all the operations and expertise that is required to run a successful and sustainable plan as well as build the foundation for the sustainable growth that will be crucial to eternalHealth’s success. Our team members are flexible and able to play different roles, while staying committed to teamwork and collaboration, and passionate about sustainable change.
Responsibilities:
- Collaborate on day-to-day clinical operations of the health plan, including complex care management, care coordination, disease management, and transition of care.
- Work on member- and provider-based interventions to improve quality and outcomes of care and reduce avoidable costs.
- Develop and refine clinically related compliance reporting and auditing activities.
- Work with a high performing team of clinical and non-clinical professionals that will deliver exceptional care while meeting quality and delivery targets.
- Follow eternalHealth’s strategic goals related to population health management and quality improvement, including setting and following the direction for analytics and existing quality measures.
- Interact regularly with executive team and department heads to develop and execute upon eternalHealth’s overall company direction and goals, including KPIs related to cost, quality, operations, and outcomes of member care.
- Ensures applicable Medicare(and any other LOB such as Mass Connector) requirements for clinical services activities and reporting are met.
- Must understand and maintain confidentiality of business information, including Protected Health Information (PHI), as required by HIPAA and company policy.
- Comply with all guidelines established by the Centers for Medicare and Medicaid (CMS) and Massachusetts Department of Insurance (DOI) and guidelines set forth by other regulatory agencies, where applicable, and defined in eternalHealth policies.
- Excellent written and communication skills.
- Creative, strategic, and continuously striving for improvement.
- Flexible and able to ramp-up quickly on different projects in order to support the team as needed in a fast-paced start-up environment.
- Ability to think outside the box and offer creative and compliant solutions to existing and new problems.
- Other duties as assigned.
Requirements:
- Active RN License.
- 3+ years of work experience in care management.
- Interpersonal skills with the ability to work in a fast-paced environment and health plan as an independent contributor with little supervision or as an active team member depending on the situation and needs.
- Strong technical skills, including with Microsoft Suite (Excel, PowerPoint, Project, etc.) and other collaborative tools.
- Experience coordinating with cross-functional teams and/or external partners/stakeholders.
- Ability to work on-site at eternalHealth's downtown Boston office.
Preferred:
- Bachelor’s degree in Nursing or applicable experience.
- Master’s degree in business administration, healthcare administration, related field, a plus. Or applicable experience in a clinical or managed care environment.
- 1+ years of Health Plan experience.
- Experience in program management and/or design or implementation.
- Have knowledge around industry best practices and regulatory compliant reporting.
Working with eternalHealth: eternalHealth is an Equal Opportunity Employer which means that we are committed to upholding discrimination-free hiring practices. As a woman-led company, and one committed to diversity at all levels, we strive for an organization of inclusion and acceptance. We are changing healthcare for the better, starting with our own diverse and passionate teams. As an eternalHealth employee you will be empowered to contribute to our teams and strategy, regardless of previous healthcare experience. Our valued team members are encouraged and expected to offer new solutions and creative input, all while keeping in line with eternalHealth’s mission, values, and compliance standards.
Accommodations: Any eternalHealth applicant will be considered based entirely on their individual qualifications. Should you require reasonable accommodations during the application process (which may include a job-related assessment) please contact us separately; email HR@eternalhealth.com with the email subject “Reasonable Accommodations – Applicant Name Here”.
