Copy of Remote Manager Case Management

Job Description

In this position you will lead this department in meeting their complex care management goals. This role involves managing the outreach to select patients identified by Blue Cross Blue Shield.

ICD 10 codes, readmissions and frequency of ER visits.This role is responsible for project management and supervision of the Case Managers.

Over the course of the fiscal year, you will work to meet the Key Performance Indicators around program enrollment. The ideal candidate will be Registered Nursing Degree from an accredited school.

5+ years nursing experience in an acute care setting (Care Management experience a plus).

What You’ll be doing

• Departmental expectations; staff hiring, orientation, auditing, and reviews; time management; motivation; and performance improvement
• Project Management and delegation of duties to ensure coverage for all tasks
• Prioritization of data, tasks, and requirements : Delegation with expertise of departmental tasks and processes
• Representative for BCBS audits with development of actions plans for each individual IPA to ensure compliance and incentive payouts
• Oversee all projects, daily tasks and PHM activities in an organized and efficient manner
• Ensure access to EMR systems for department staff
• Monitor staff maintenance of HIPPA regulations
• Communication with IPA Administrators and Client Business Managers to ensure resolution of any concerns.
• Identification and dissemination of Health Plan announcements applicable to Population Health

Qualifications

WHAT YOU'LL NEED TO HAVE

• At least 2 5+ years of related work experience.
• 3+ years of management experience
• Knowledge set including : evidenced based practices, social determinants / barriers of health, motivational interviewing, and goal setting
• Experience working with complex data sets
• Healthcare data experience

Would Love For You Have :

• In depth knowledge of MSA and UM / PHM Plan with ability to decipher meanings and changes
• In depth knowledge of all contracted IPAs
• Knowledge of national guidelines and care trends / incentives, crossovers with quality, and insights to analytics

Additional Information

The base pay range for this role $95K per year paid bi-weekly per our standard payroll practices. Final base pay decisions are dependent upon a variety of factors which may include, but are not limited to : skill set, years of relevant experience, education, location, and licensure / certifications.

BENEFITS :

While you are hard at work advancing value-based healthcare, we are here to ensure YOU have the care you and your family need and the opportunities for growth and development.

Our commitments to you include :

• Work from Home : Guidehealth is a fully remote company, providing you the flexibility to spend less time commuting and more time focusing on your professional goals and personal needs.
• Keep Health a Priority : We offer comprehensive Medical, Dental, and Vision plans to keep you covered.
• Plan for the Future : Our 401(k) plan includes a 3% employer match to your 6% contribution.
• Have Peace of Mind : We provide Life and Disability insurance for those "just in case" moments. Additionally, we offer voluntary Life options to keep you and your loved ones protected.
• Feel Supported When You Need It Most : Our Employee Assistance Program (EAP) is here to help you through tough times.
• Take Time for Yourself : We offer Flexible Time Off tailored to meet your needs and the needs of the business, helping you achieve work-life balance and meet your personal goals.
• Support Your New Family : Welcoming a new family member takes time and commitment. Guidehealth offers paid parental leave to give you the time you need.
• Learn and Grow : Your professional growth is important to us. Guidehealth offers various resources dedicated to your learning and development to advance your career with us.

COMPENSATION :

The listed compensation range listed is paid bi-weekly per our standard payroll practices. Final base pay decisions are dependent upon a variety of factors which may include, but are not limited to : skill set, years of relevant experience, education, location, and licensure / certifications.

OUR COMMITMENT TO EQUAL OPPORTUNITY EMPLOYMENT

Diversity, inclusion, and belonging are at the core of Guidehealth’s values. We are an equal opportunity employer. We enthusiastically accept our responsibility to make employment decisions without regard to race, religious creed, color, age, sex, sexual orientation and identity, national origin, citizenship, religion, marital status, familial status, physical, sensory, or medical disability, Family and Medical Leave, military or veteran status, pregnancy, childbirth or other related medical conditions, or any other classification protected by federal, state, and local laws and ordinances.

Our management is fully dedicated to ensuring the fulfillment of this policy with respect to hiring, placement, promotion, transfer, demotion, layoff, termination, recruitment advertising, pay, and other forms of compensation, training, and general treatment during employment.

OUR COMITTMENT TO PROTECTION OF PATIENT AND COMPANY DATA

This position is responsible for following all Security policies and procedures in order to protect all PHI and PII under Guidehealth’s custodianship as well as Guidehealth Intellectual Properties.

For any security-specific roles, the responsibilities would be further defined by the hiring manager.