Job Description
Job DescriptionDescriptionAstrana Health is seeking a Manager - Care Management to oversee our telephonic and in-home Care Management services and activities for high-risk patients, with a primary goal to prevent unnecessary utilization and improve patient outcomes. This manager would oversee our clinical team of providers, registered nurses, social workers, community health workers and care coordinators.
We are seeking candidates who have an active independent license as an RN, LCSW, LPC, PhD or PsyD for this position.
Our Values:
- Put Patients First
- Empower Entrepreneurial Provider and Care Teams
- Operate with Integrity & Excellence
- Be Innovative
- Work As One Team
What You'll Do
- Manage clinical services including oversight of clinical policies and procedures and daily activities of clinical team staff.
- Ensure adequate staffing to conduct care management activities and effectively distribute workloads.
- Ensure team members receive appropriate training to serve the population and demonstrate effective engagement activities for individuals with various disabilities including chronic physical and behavioral health conditions.
- Ensure Integrated Clinical Services staff are trained on NCQA and HEDIS measures and processes to ensure compliance.
- Ensure all programs and clinical operations are in full compliance with state and federal regulations, including HIPAA.
- Ensure compliance with plan’s emergency management policies, procedures and processes by acting as liaison with other business units.
- Monitor the effectiveness of existing procedures and outreach/intervention efforts in demonstrating positive outcomes for patients.
- Ensure appropriate care planning, education and interventions are conducted for members defined to be at risk.
- Ensure staff coordinate exchange of information between behavioral health and medical providers in developing comprehensive care plans for at-risk members.
- Monitor data to address quality measures, trends or potential improvement opportunities including provider issues, service gaps and patients’ needs
- Monitor effectiveness of care management programs and make adjustments when opportunities are found.
- Other duties as assigned.
Qualifications
- BSN in Nursing or a related field or graduation from an accredited School of Nursing. Licensed in Rhode Island with additional Massachusetts RN license preferred
- Active RN, LMSW/LCSW, LMFT, LPC, PhD or PsyD license in the applicable state (RI a must)
- Minimum of 3 years of care management and/or utilization management experience.
- In-depth knowledge of assessment, diagnosis, and treatment of individuals with complex needs, as well as care management, mental health community resources, and local health delivery systems.
- Previous experience leading a functional area, managing cross-functional teams on large-scale projects, or supervisory experience, including hiring, training, work assignment, and performance management. Effective communication skills
- Extensive experience with Microsoft Office Suite (Word, PowerPoint, Excel)
- Professional work ethic
- Strong comfort with working in a fast-paced environment
- An authentic passion for improving the lives of complex high risk patients and advancing value-based care
Environmental Job Requirements and Working Conditions
- This is a hybrid position. The office is located at 1301 Atwood Avenue in Johnston RI.
- Our target compensation for this position is $110 - $120K per year.
Astrana Health is proud to be an Equal Employment Opportunity and Affirmative Action employer. We do not discriminate based upon race, religion, color, national origin, gender (including pregnancy, childbirth, or related medical conditions), sexual orientation, gender identity, gender expression, age, status as a protected veteran, status as an individual with a disability, or other applicable legally protected characteristics. All employment is decided on the basis of qualifications, merit, and business need. If you require assistance in applying for open positions due to a disability, please email us at humanresourcesdept@networkmedicalmanagement.com to request an accommodation.
Additional Information:
The job description does not constitute an employment agreement between the employer and employee and is subject to change by the employer as the needs of the employer and requirements of the job change.