Manager, Delegated Care Management RN
3 days ago
Title: Manager, Delegated Care Management RN Role Description This position is responsible for a range of activities supporting delegated Care Management/Care Coordination functions. These may include, but are not limited to, responsibility for implementation of new delegated Care Management functions, including project planning, system readiness, accountability for reporting requirements, hiring, training, and internal/external communication required for launch. The Manager ensures departmental adherence to program standards, ensures the care management program meets compliance requirements and metrics as set by the health plan and CMS, provides initial and ongoing education to staff, and serves as the liaison between OSH and insurance providers, other business partners, vendors and internal stakeholders as required. Core Responsibilities * Manage a team of RN Care Managers and Care Navigators, responsible for the performance management to deliver an unmatched patient experience and ensure delegation compliance. * Audit individual charts according to QA Audit Protocols to ensure compliance with program responsibilities and best practices * Possess knowledge of contractual, accreditation, federal and business requirements for assigned program and ensure compliance with program requirements and develop corrective action plans as needed * Establish work procedures and processes that support the company and departmental standards, procedures and strategic directives * Establish workflows that meet compliance requirements and align with organization-wide clinical protocols * Lead the review of policies and procedures, program descriptions, and evaluations; * Conduct training for new team members and other internal parties as required * Provide statistical and performance feedback, and coaching on a regular basis to each team member in their assigned region * Create and maintain a high-quality work environment so team members are motivated to perform at their highest level * Provide continual evaluation of processes and procedures. Responsible for suggesting methods to improve area operations, efficiency, and service to both internal and external staff * Collaborate with other OSH program leaders to implement initiatives in support of integrating delegated services with core OSH care model (e.g. care team, social work, behavioral health, utilization management, patient engagement, central telehealth, etc.) to promote patient outreach and engagement and identify and address patient needs. * Serve as point of contact for / management of health plan relationships related to delegated care management * Oversight of delegated entities and internal operating partners servicing Care Coordination, including management of operational performance and program execution * In partnership with Business Intelligence, set, implement and monitor system configuration requirements in accordance with operational and regulatory specifications required for new programs * Complete report submissions, including validation where needed * Other duties as assigned What weâre looking for: * Bachelorâs in Nursing * Active RN license within one or more OSH states * Willingness to obtain cross-state licensure, as needed * 5+ years of healthcare experience, preferably in a primary care and/or managed care setting * 2+ years direct supervisory experience * Certified Case Manager (CCM) or equivalent case management certification required, or willingness to obtain within 12 months of hire * Knowledge of Medicare/Medicaid and NCQA requirements * Practical and operational experience in a managed care environment, preferably with working knowledge of related legal/regulatory/health plan requirements * Demonstrated experience leading teams, competence with change management, and leading process improvement * Knowledge relating to healthcare delivery workflows, project management, and quality improvement is required * Prior experience in a similar role at an IPA, Health Plan or MSO will be advantageous * Strong teamwork and interpersonal skills. Must be able to work effectively with cross functional groups, fostering teamwork with a commitment to quality * Passion for excellence, willing to go the extra mile to achieve objectives and ensure consistently high quality work product * Ability to succinctly summarize and synthesize large amounts of information * Quick learner comfortable with a high level of ambiguity * Strong accountability and discipline against timelines and deliverables * Strong clinical and assessment skills * Outstanding verbal and written communication skills * Ability to work independently and maintain flexibility in a fast-paced, start-up environment * Self-starter with a high level of accountability and responsibility for the outcome of care * Highly organized and able to manage multiple priorities appropriately * Independent problem-solving skills * Able to work collaboratively and build enduring relationships with providers, patients and the multidisciplinary team. * A flexible, positive attitude * Proficient with Microsoft Office, Google Suite, and healthcare EMRs * US work authorization * Someone who embodies being âOakyâ What does being Oaky look like? * Radiating positive energy * Assuming good intentions * Creating an unmatched patient experience * Driving clinical excellence * Taking ownership and delivering results * Being relentlessly determined Why Oak Street Health? Oak Street Health is on a mission to rebuild healthcare as it should be, providing personalized primary care for older adults on Medicare, with the goal of keeping patients healthy and living life to the fullest. Our innovative care model is centered right in our patient communities, and focused on the quality of care over volume of services. We are an organization on the move With over 200+ locations and an ambitious growth trajectory, Oak Street Health is attracting and cultivating team members who embody Oaky values and passion for our mission. Oak Street Health Benefits: * Mission-focused career impacting change and measurably improving health outcomes for medicare patients * Paid vacation, sick time, and investment/retirement 401K match options * Health insurance, vision, and dental benefits * Opportunities for leadership development and continuing education stipends * New centers and flexible work environments * Opportunities for high levels of responsibility and rapid advancement Oak Street Health is an equal opportunity employer. We embrace diversity and encourage all interested readers to apply. Learn more at www.oakstreethealth.com/diversity-equity-and-inclusion-at-oak-street-health
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Manager, Delegated Care Management RN
6 days ago
Chicago, United States Oak Street Health Full timeDescription Title: Manager, Delegated Care Management RN Role Description This position is responsible for a range of activities supporting delegated Care Management/Care Coordination functions. These may include, but are not limited to, responsibility for implementation of new delegated Care Management functions, including project planning,...
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