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
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