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Manager, Delegated Care Management RN
3 months ago
Description
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 theperformance management to deliver an unmatched patient experience and ensure delegation compliance.
Audit individual charts according to QA Audit Protocols to ensure compliance withprogram responsibilities and best practices
Possess knowledge of contractual, accreditation, federal and business requirementsfor assigned program and ensure compliance with program requirements anddevelop corrective action plans as needed
Establish work procedures and processes that support the company anddepartmental 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 asrequired
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 aremotivated to perform at their highest level
Provide continual evaluation of processes and procedures. Responsible forsuggesting methods to improve area operations, efficiency, and service to bothinternal and external staff
Collaborate with other OSH program leaders to implement initiatives in support of integrating delegated services with core OSH care model (. care team, social work, behavioral health, utilization management, patient engagement, central telehealth, 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 managedcare 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 withworking knowledge of related legal/regulatory/health plan requirements
Demonstrated experience leading teams, competence with change management, andleading process improvement
Knowledge relating to healthcare delivery workflows, project management, andquality 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 crossfunctional groups, fostering teamwork with a commitment to quality
Passion for excellence, willing to go the extra mile to achieve objectives and ensureconsistently 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
