CLINICAL MANAGER, CARE MANAGEMENT & TRANSITION OF CARE

Company: Universal Health Services, Inc.
Location: Reno
Posted on: March 16, 2023

Job Description:

Responsibilities

Job Summary: This position is responsible for the day-to-day management of the Care Management (CM) program, D-SNP Care Management Program, and Transitions of Care. The position entails staff supervision and personnel management in the department. The Clinical Manager is responsible for the implementation of and management of a comprehensive Care Management and Transitions of Care Program that is accountable for the management of members with catastrophic/complex conditions. Will manage a staff of Registered Nurses, Licensed Clinical Social Workers, and non-clinical staff, who utilize the Case Management process to 1) assess the health care needs of the member; 2) develop a comprehensive treatment plan complete with specific goals and objectives; 3) implement a treatment plan in collaboration with the PCP and the other providers involved in the patient's care; 4) negotiate and coordinate services for the patient; 5) monitor and evaluate the effectiveness of the plan in achieving the goals and objectives; and 6) change and modify the plan as needs and situations change. Ensures staff are appropriately trained and deployed to support the needs of Prominence Health Plan and its members. Develops policies, procedures, workflows, and processes to ensure comprehensive Care Management and Transitional Care services are available to Prominence members and ensures all staff within the department adhere to the CMSA Standards of Practice for Case Management.Additional responsibilities include ensuring that the D-SNP CM program in the model of care (MOC) meets or exceeds regulatory and accreditation requirements for the Centers for Medicare and Medicaid Services (CMS), state Medicaid offices (as relevant), and NCQA, and leads all efforts associated with the successful operation of a CM program. Will interact with hospital case management/discharge planners to ensure they are informed about the Prominence TOC program and the Prominence expectations for collaboration in the care continuum process.
Qualifications

Requirements:

• Registered Nurse with a BSN or MSN degree
• Active, unrestricted, current, and valid RN licenses in the States of Practice (Nevada, Texas and/or Florida).
• Certified Case Manager (CCM) or Certified Professional in Healthcare Quality (CPHQ), or ability to obtain within the required time
• Minimum Five (5) years of management experience in a managed care environment. Equivalent combination of education and experience will be considered.
• Recent (within past 3 years) working knowledge of Milliman Care Guidelines, preferred.
• Minimum of five years (5) in clinical medical/surgical nursing practice within a hospital setting, preferred.
• Ability to effectively communicate in English (Nevada, Texas, and Florida markets), Spanish (Texas and Florida markets), and/or Spanish, French Creole, and/or Tagalong (Florida market), both verbally and in writing depending on the State of RN licensure and employment location.
• Experience executing strategies; organizing and prioritizing multiple projects and relationships with key stakeholders and program implementers.
• Written and oral communication skills, including large and small group presentations, group facilitation and training.
• Ability to influence others and work collaboratively with key partners to achieve positive results.
• Ability to present ideas and programs to key strategic alliances, professional volunteers, and funding partners.
• Computer Skills: Smartsheet, SharePoint, Microsoft Office (Word, Excel, PowerPoint), and database software.
• Empathetic, Caring, Compassionate Listener.
• Able to work with a diverse multicultural and socioeconomic population.
• Familiarity with health care delivery and/or health insurance programs.
• Knowledge of medical terminology.
• Strong problem-solving and critical thinking skills.
• Experience working with the Medicare and Medicaid population segment preferred.
• Knowledge of Medicare/ Medicaid processes and compliance standards
• Ability to travel local and regional up to 25-50% of time. EEO StatementAll UHS subsidiaries are committed to providing an environment of mutual respect where equal employment opportunities are available to all applicants and teammates. UHS subsidiaries are equal opportunity employers and as such, openly support and fully commit to recruitment, selection, placement, promotion and compensation of individuals without regard to race, color, religion, age, sex (including pregnancy, gender identity, and sexual orientation), genetic information, national origin, disability status, protected veteran status or any other characteristic protected by federal, state or local laws. We believe that diversity and inclusion among our teammates is critical to our success. NoticeAt UHS and all our subsidiaries, our Human Resources departments and recruiters are here to help prospective candidates by matching skillset and experience with the best possible career path at UHS and our subsidiaries. We take pride in creating a highly efficient and best in class candidate experience. During the recruitment process, no recruiter or employee will request financial or personal information (Social Security Number, credit card or bank information, etc.) from you via email. The recruiters will not email you from a public webmail client like Hotmail, Gmail, Yahoo Mail, etc. If you are suspicious of a job posting or job-related email mentioning UHS or its subsidiaries, let us know by contacting us at: https://uhs.alertline.com or 1-800-852-3449.

Keywords: Universal Health Services, Inc., Reno , CLINICAL MANAGER, CARE MANAGEMENT & TRANSITION OF CARE, Healthcare , Reno, Nevada