Clinical Quality Manager

6 days ago

Lewiston, Maine, United States St. Joseph Physician Services Full time
Job Summary

The Care Manager - Value Based Program is a key member of our collaborative care team, working closely with patients' primary care providers and other healthcare professionals to ensure seamless transitions of care. This role is responsible for managing quality and incentive-based programming, providing direction to quality assigned associates, and serving as a primary partner in strategic community incentive alliances.

Key Responsibilities
  • Support and coordinate healthcare with patients' care teams across the care continuum to ensure smooth transitions of care.
  • Ensure effective communication and collaboration with SJRMC Discharge Planning, Physician, and facility staff to foster continuity of care.
  • Work with interdisciplinary teams to develop discharge plans of care for high-risk patient populations.
  • Engage primary care physicians in transition of care management and assist with discharge plans and oversight post-acute stays.
  • Conduct post-discharge contact/visit with each patient, establishing a relationship that fosters smooth transitions through the continuum and for at least 90 days after discharge.
  • Provide patient education about current conditions, recommended treatments, medications, and required follow-up for patients with chronic diseases.
  • Maintain appropriate records and documents treatment recommendations and follow-up in patients' health records to be shared with treating providers.
  • Participate in caseload consultation with patients' primary care and consulting teams as needed, communicating treatment recommendations or changes to care teams and facilitating referrals as indicated and ordered.
  • Collaboratively develop and manage care plans and institute measures to improve overall health of our patient population.
  • Serve as a Patient Experience advocate in all interactions and activities associated with role enactment.
  • Ensure providers receive ongoing education related to quality indicators and documentation integrity of such.
  • Ensure the maintenance of an appropriate, continuous, and effective quality improvement program for SJMG's multi-specialty clinics.
  • Establish and maintain effective, collaborative relationships within the clinic(s) and across departments throughout the Medical Group and SJRMC.
  • Provide leadership and oversight of front-line problem-solving for provider groups in relationship to all clinic quality programming, including MIPS, BPCI, BCI, and other value-based care planning initiatives rooted in provider activity.
  • Promote partnerships with providers by communicating quality activities, providing feedback on results of practice-specific assessments, and collaboratively developing improvement plans as needed.
  • Act as primary clinic-based liaison with all community-based quality and share of cost partnerships.
  • Participate in and support identified process improvement initiatives and projects.
  • Display a positive attitude, eagerness to learn, initiative, and ability to adapt and change to new roles and duties.
Requirements
  • High School Diploma or GED and one of the following:
  • Certified or Registered Medical Assistant (CCMA)
  • Idaho Licensed Practical Nurse (LPN)
  • Idaho Licensed Social Worker (BSW or MSW)
  • Excellent communication (oral & written) and interpersonal skills
  • Minimum of three (3) years of clinical experience, resulting in excellent clinical skills & judgment

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