CLINICAL MANAGER, CARE MANAGEMENT & TRANSITION OF CARE
Company: Universal Health Services, Inc.
Posted on: March 16, 2023
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.
Keywords: Universal Health Services, Inc., Reno , CLINICAL MANAGER, CARE MANAGEMENT & TRANSITION OF CARE, Healthcare , Reno, Nevada
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