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Posted: 30-Jan-25
Location: Irving, Texas
Categories:
Internal Number: 249852
Summary:
The Manager Care Management is responsible for day-to-day oversight, coordinating, organizing, and managing functions and resources for the Care Management team supporting nurse navigation and post-acute. This role collaborates and coordinates with Care Management Leadership and colleagues to achieve standardization of assigned functions and responsibilities. This role combines the clinical and the financial components to achieve the best possible outcomes for the patients served and the organization. This includes the CHRISTUS Health CIN/ACO, Health Plan, and other initiatives as they arise.
Responsibilities:
- Meets expectations of the applicable OneCHRISTUS Competencies: Leader of Self, Leader of Others, or Leader of Leaders.
- Develops protocols and procedures to improve staff productivity. Works with EMR teams to ensure efficient workflows and data.
- Collaborates with the Care management leadership team to identify key opportunities to help reduce total cost of care, develop strategies, action plans and escalate barriers to leadership.
- Utilizes systems within the Care Management Department to support an effective and proactive care management process across the continuum, working closely with and aligning with inpatient and post-acute efforts supporting a patient-centered care management model that spans the continuum. Collaborates with inpatient and post-acute providers and staff to ensure seamless transitions of care.
- Directs daily operations to achieve effective utilization of personnel resources consistent with patient and ministry needs. Assist in the development of annual departmental goals and objectives. Assists in the development of strategic departmental plans and initiatives. Fosters integration and strong collaborative partnerships with quality, inpatient care management and post-acute in supporting and engaging in clinical integration activities in order to optimize high-quality, cost-efficient care.
- Oversee management of post-acute spending and utilization such as but not limited to home health recertification in order to reduce the total cost of care.
- Works in concert with organization colleagues to achieve standardization of operations.
- Understands the financial impact of contracts and changing payment models from fee-for-service to value-based care. Works collaboratively with staff and other key stakeholders to reduce total cost of care and overall utilization.
- Takes initiative to educate self and staff on the changing healthcare landscape including fee-for-service to value-based models, care model innovations, research, and leading evidence-based practices.
- Partners effectively with the Health Plan to integrate services driving value and efficiency for the company and VBC stakeholders.
- Subject matter expert in requirements for certifications required for case management such as NCQA.
- Creates, develops, and provides population health/ACO Education to support CHRISTUS employed or affiliated physician network.
- Must analyze clinical, financial, and social situations, identifying problems and alternative courses of action.
- Demonstrate expertise in value-based care ? improving outcomes while managing total cost of care ? in a population segment-specific manner.
- Think with an enterprise mindset and to continuously challenge the status quo.
- Motivate people and teams while raising performance levels year over year.
- Articulate, persuasive, communicator who is adept at handling executive and difficult audiences well including the ability to adapt style to audience.
- Act independently and offer suggestions and new ideas for improving performance and operations.
Job Requirements:
Education/Skills
- Bachelor of Science in Nursing (BSN) required
- Masters in nursing, social work, or healthcare administration preferred
Experience
- 5+ years of working with accountable care organizations and/or value-based care to support care management/case management of medical costs required
- 3+ years of ambulatory care management experience required
- Demonstrated expertise in Medicare Advantage required
- Experience with MS Office Products ? Word, Excel, PPT, and Visio required
- Working experience with Population Health Management technologies and approaches (e.g., high-risk user stratification tools, cost/quality/utilization trend analysis, provider performance tools) required
- Experience supporting value-based care performance & strategy required
- Expertise in Medicare Advantage required
- Strong presentation skills with the ability to present to leadership required
- EPIC EMR experience preferred
Licenses, Registrations, or Certifications
- RN licensure required
- BLS required
- Case Management certification preferred
Work Type:
Full Time
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