Accepts J1 Visas: No Accepts H1B Visas: No Loan Assistance:Not Specified Practice Type:Employee Academic Opportunity:No Telemedicine Opportunity:No
The purpose of this position is to is responsible for supporting cost-effective, high-quality health care for patients enrolled in the long-term care facilities in their region by managing the activities of a team of Providers and supports national clinical strategy and leadership. The Program Manager is responsible for conducting clinical audits of the providers to ensure excellent service deliver, and that care is administered in accordance with Medicare, Medicare Advantage, and all other compliance programs, state laws and regulatory compliance, privacy and security, detecting, preventing, and correcting fraud, waste, and abuse.
Description of Required Duties and Tasks: Works closely with the leadership at the long-term care facilities in their region and company leadership to meet the key performance metrics for a market Directly manages a team of Providers RN Managers who are providing care in nursing facilities Ensures all patient services are delivered on time and effectively and within the scope of the plan. Collaborates with colleagues to explore innovative delivery models or enhancements to current delivery models and care practices. Identifies opportunities for process improvements and staff education to produce optimal outcomes Serves as a subject matter expert (SME) on the ISNP plan and care model. Collaborates on the development of training materials to support clinical training Participates in clinical training initiatives Collaborates with business leaders to implement new markets and programs Reviews daily, weekly and monthly management reports to monitor and manage care delivery. Collaborates with vendors and community organizations for improved service delivery Oversees the review and resolution of complaints and grievances Participates in company-wide initiatives to ensure consistency and high-quality in the clinical delivery of care Participates in company-wide quality improvement initiatives across all aspects of the organization
Required Skills: APN license required 3-5 Years of experience in long term car or chronically ill patients Strong experience in leadership and business preferred. Strong background and familiarity with Medicare, Medicaid, ISNP, Nursing Facility and Managed Care preferred Strong working knowledge of HEDIS/ STARs preferred 1-3 years of practice experience needed 1-3 years of management experience in long term care, home health or chronic condition management preferred Driver’s license without restrictions and good driving record Working knowledge of MS Office including Word, Excel, PowerPoint, SharePoint, and Visio.
Supervisory Responsibilities: First line supervision and delegation of duties of all the Providers and RN Case Managers in direct clinical care services. Frontline oversight, planning, and delegation of onboarding activities of new employees within the designated region. Responsible for provider relations issues that are not at a regional or corporate level that would affect P&Ps.
Social Interactions Interpersonal contacts with individuals within or outside the organization may occasionally result in unexpected and immediate demands, requiring restructuring of priorities.
Impact of Actions: An error in action may affect the entire organization and can lead to major cost and inconvenience that could jeopardize the organization’s long-term performance.
Attendance: Is consistently at work and on time; Ensures work responsibilities are covered; Arrives at meetings on time.
Attitude: Very supportive of the organization’s policies and procedures.
Cooperation: Displays ease working with others; Contributes ideas and skills to team; puts success of team above own interests.
Dependability: Accepts responsibility for own decisions, actions and results; Able to maintain dependable behavior in times of crisis or complexity.
Development: Seeks increased responsibility; self-starter, resourceful. Willing to continue education through various coursework.
Ethical Behavior: Upholds organizational values and abides by state and federal regulations; Maintains confidentiality of HIPAA information; Treats others with respect.
Job and Industry Knowledge: Demonstrates knowledge of the position and industry; Seeks additional information.
Productivity and Quality of Work: Maintains high level of performance while demonstrating commitment to accuracy and thoroughness.
Public Relations: Possesses good interpersonal skills while dealing with emotional or difficult situations; Responds promptly to customer’s needs.
Punctuality: Arrives at work on time and returns from lunch and breaks appropriately.
American Health Partners