Clinical Quality Lead
4 days ago
Careforth is a pioneering organization in the caregiving space, dedicated to supporting family caregivers across the United States. We provide a comprehensive range of services, including in-person home visits, remote coaching, and a proprietary digital collaboration app, to empower caregivers with the support, guidance, and confidence they need. Our commitment to building lasting relationships with caregivers and their families has earned us a reputation as a trusted partner in the caregiving community.
Job SummaryThe Care Management Lead (CML) plays a critical role in ensuring the clinical quality and compliance of our care management services. Reporting to the Manager, Care Management, the CML is responsible for supporting the clinical quality and compliance of care management services, serving as the lead escalation point for clinical issue management and support. This includes collaborating with teams to ensure compliance with documentation standards, required regulations, and best practices.
Key Responsibilities- Respond to requests from caregivers and consumers, communicating with team members regarding concerns or emerging issues.
- Track consumer risk and work with care teams to adjust the plan of care (POC) as appropriate.
- Manage the case conference process, facilitating case review and discussion of risk mitigation strategies and follow-up.
- Resolve and respond to complaints or grievances expressed by consumers or caregivers or their stakeholders.
- Drive effective utilization of established best practices and protocols across the team, ensuring compliance with contractual obligations and NCQA accreditation requirements; observe virtual/home visits with care management team members and review documentation for quality.
- Coach and mentor care team members, identifying individual or team training needs, and providing training to new clinical team members and others as needed.
- Assist the Manager, Care Management, with incident investigations and reporting.
- Ensure continuous survey and audit readiness, maintaining compliance with company policies and practices, as well as federal/state/local regulations.
- May supervise administrative staff.
- Perform other projects and duties as assigned.
- Bachelor's degree or equivalent, preferably in a healthcare or social services discipline, along with a minimum of 4-6 years of experience in case management and care planning for older adults with complex medical conditions and/or individuals with disabilities, preferably in a healthcare, long-term care, social service, or community setting.
- RN license.
- Demonstrated ability to coach and mentor others.
- Working knowledge of case management systems, community service and delivery systems, and Microsoft Office suite.
- Ability to travel (usually by automobile) within assigned geographic area; valid driver's license and automobile insurance required.
- Additional state-specific qualifications may be required.
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