Manager, Care Coordination
3 weeks ago
What's Your Why?
• Are you looking for a career opportunity that will help you grow personally and professionally?
• Do you have a passion for helping others achieve Better Health?
• Are you ready to join a growing team that shares your mission?
Why Join Our Team: At Better Health Group, it's our commitment, our passion, and our culture that sets us apart. Our Team Members make a difference each and every day They support our providers and payors, ensuring they have the necessary tools and resources to always deliver best-in-class healthcare experiences for our patients. We don't just talk the talk - we believe in it and live by it. Be part of a team that shares your passion and drive, and start living your purpose at Better Health Group.
Position Objective:
The Care Coordination Manager oversees and monitors the organization’s Care Coordination functions. The goal is to achieve clinical, financial, and utilization goals by focusing on clinical case reviews and audits, clinical program improvements, and quality outcomes (i.e., reduction in emergency room visits and hospital admissions, improved member satisfaction) and cost effectiveness. The Care Coordination Manager manages a clinical team. The incumbent will report to the Vice President, Health Services Operations.
Responsibilities:
- Perform routine audits and clinical case reviews for High Cost Cases and for other Programs and summarize findings for meetings with health plan partners and providers
- Facilitate and Collaborate in High Cost Review and Other Clinical Program Focused Review Meetings with Chief Medical Officer and other Stakeholders
- Lead and mentor a team by providing clinical guidance and supervision to assigned team members in order to promote efficient and effective delivery of services
- Conduct regular audits and assessments of team members to ensure quality outcomes
- Evaluate and document staff performance; coach staff to improve both quality and quantity of skills attaining optimal performance
- Work with the leadership team to develop and implement ongoing training and development
- Actively facilitate staff training and meetings
- Track, monitor, and communicate trends in Key Performance Indicators and identify drivers and roadblocks to high-quality of care
- Collaborate with cross functional teams to identify and resolve challenges and coordinate activities
- Resolve issues and mitigate conflict encountered during daily operations; appropriately escalate issues to the Vice President, Health Services Operations
- Conduct regular meeting with internal and external stakeholders (e.g., payers, hospitals, SNFs, providers) to discuss program initiatives and progress
- Stay updated with industry regulations, guidelines, and best practices to ensure compliance and drive continuous improvement
- Utilize data to track, trend and report productivity and outcome measures; work with the management team to implement necessary improvement strategies.
- Assist with the preparation of department dashboards and reports
- Perform employee performance reviews
- Participate in the development and implementation of departmental Playbooks, and monitor/ensure compliance and consistency; review and revise workflows to ensure maximization of resources
- Other duties as assigned
Position Requirements/ Skills:
- A bachelor's degree in Nursing or related medical field
- Proof of successful completion of educational requirements for a Registered Nurse (RN) as defined by the state of Florida, as well as, proof of such licensure in good standing
- Licensure to be obtained for additional states or territories as required
- 3+ years of Care Coordination experience
- Complex Case Management (CCM) certification is a plus
- Minimum of 2 years leadership/management experience
- Proven success working with interdisciplinary teams
- Proficient with Google Suite (Drive, Docs, Sheets, Slides) and Microsoft Office (Word, Excel, PowerPoint) for real-time collaboration
Physical Requirements:
- Ability to remain in a stationary position, often standing or sitting for prolonged periods of time
- Communicating with others to exchange information
- Repeating motions that may include the wrist, hands, and/or fingers
- Must be able to lift at least 15 lbs at times
- Ability to operate a motor vehicle
Key Attributes/ Skills:
- Has a contagious and positive work ethic, inspires others, and models the behaviors of core values and guiding principles
- An effective team player who contributes valuable ideas and feedback and can be counted on to meet commitments
- Is able to work within our Better Health environment by facing tasks and challenges with energy and passion
- Pursues activities with focus and drive, defines work in terms of success, and can be counted on to complete goals
- Demonstrated ability to handle data with confidentiality
- Ability to work cross-functionally with multiple teams; ability to work independently with minimal supervision
- Excellent organizational, time-management, and multi-tasking skills with strong attention to detail
- Excellent written and verbal communication skills; must be comfortable communicating with senior-level leadership, providers, and health plans
- Strong interpersonal and presentation skills
- Strong critical thinking and problem-solving skills
- Must be results-oriented with a focus on quality execution and delivery
- Appreciation of cultural diversity and sensitivity toward target patient populations
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