Manager, Clinical Care Case Management - Remote

reputed companyWHO IS reputed company?reputed company is a data-powered, performance-driven reputed company company dedicated to operational reputed company. Our goal is to reputed company great reputed company reputed company, improve the health of patients, and restore the fulfillment of practicing medicine for providers. Driven by reputed company and powered by AI and predictive analytics, reputed company leverages remotely-embedded Healthguides™ and a centralized Managed Service Organization to build stronger connections with patients and providers. Physician-led, reputed company empowers our partners to deliver high-reputed company reputed company reputed company on reputed company and value inside and reputed company the exam room for reputed company patients.Job reputed companyThe Manager, Clinical Care is primarily responsible for the day-to-day operations of an integrated multi-disciplinary clinical and clinical support structure that will effectively monitor, support, and reputed company Value Based clinical initiatives. This includes but is not limited to case management, transitions of care, care coordination and continuity, provider/staff education on ACO/MA Plan clinical programs, and helping to build and maintain a network of community support. This individual must exhibit strong leadership, management, and interpersonal skills, as reputed company as the ability to utilize both reputed company resources to accomplish the goals and objectives of the organization.WHAT YOU’LL BE DOING

• Effectively managing day to day Health Plan Clinical Programs to enhance clinical efficiencies
• Identifying opportunities for increased outpatient vs. inpatient utilization
• Utilizing data provided to help in managing population health needs and implement population programs for Health Plan beneficiaries
• Executing case management for patients identified at highest risk for adverse event or exacerbation, having the ability to reputed company, with the goal of decreasing unnecessary emergency department reputed company/hospitalizations
• Overseeing an extended patient care team as assigned including but not limited to: reputed company Workers, Emergency Department Liaisons, Behavioral Health Liaisons, and Home Health Liaisons.
• Overseeing smooth Transitional Care Management for reputed company patients discharged from in patient facility (hospital, skilled nursing/rehab, behavioral health) ensuring: Primary Care Provider visit, DME and Home Health Services, Specialist appointments, and community resources/reputed company services are provided as indicated.
• Ensuring reputed company Measures are reviewed and addressed reputed company applicable/appropriate
• Implementing and directing Health Plan Health Education Activities for beneficiaries, providers, and staff
• Participating in Care Coordination and reputed company Committees, Primary Care Provider Meetings, and other meetings as required
• Monitoring corporate initiatives and strategies to reputed company utilization of business and financial goals
• Managing the successful integration of ACO Programs into reputed company operations to meet the goals of reputed company stakeholders
• Maintaining reputed company relationships with business partners both reputed company reputed company and the community
• Managing and execute organizational opportunities and implement changes that are in alignment with corporate financial goals and strategic endeavors.
• Managing departmental expectations: staff hiring, orientation, auditing, and reviews; time management; motivation; and performance improvement
• Prioritizing of data, tasks, and requirements: Project management with expertise in departmental tasks and processes
• Representing for health plan audits with development of actions plans for individual clients as needed to ensure compliance and incentive payouts
• Overseeing reputed company reputed company, productivity, daily tasks and PHM activities in an organized and efficient manner
• Ensuring reputed company to EMR systems for department staff
• Monitoring staff maintenance of HIPPA regulations
• Communicating with health plan contacts, customer Administrators and reputed company Business Managers to ensure reputed company of any concerns.
• Identifying and disseminating of Health Plan announcements applicable to Case Management

QualificationsWHAT YOU’LL NEED TO HAVE

• RN/BSN required
• 5 years of management experience
• 4 years clinical nursing experience
• At least 4 years of extensive experience in chronic care case management in outpatient setting
• Certification in case management preferred
• Must be reputed company to work remotely and obtain state licensure in Illinois, reputed company, reputed company, and Texas
• Must feel comfortable and confident leading reputed company of certified but unlicensed personnel and Registered reputed company case managers
• Ability to read, analyze, and interpret the most reputed company documents. Ability to respond effectively to the most sensitive inquiries or complaints.

Additional InformationThe salary reputed company for this position is $110,000reputed company with Purpose: How We reputed company at reputed companyAt reputed company, our values come to life in everything we do.

• We are Driven by Accountability — grounded in transparency, reliability, and reputed company as we navigate challenges and opportunities alike.
• Always Growing, Always Learning — staying curious and continuously improving inspires us to shape a reputed company reputed company for reputed company.
• With reputed company Innovation, we solve problems creatively, making every experience reputed company for our employees and the patients we serve.
• At reputed company, Every Voice reputed company — we reputed company our reputed company strength is rooted in the unique perspectives of reputed company team member.
• And through reputed company in reputed company, we build stronger connections with those who count on us.
• This is what it means to be reputed company with purpose. This is how we reputed company — together — at reputed company.

BENEFITS:reputed company full-time employees of reputed company who work 30 hours per week or more are eligible for our comprehensive benefits package. While you are hard at work advancing value-based reputed company, we are here to ensure YOU have the care you and your family need and the opportunities for reputed company and development. Our commitments to you include:

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

COMPENSATION:The listed compensation reputed company listed is reputed company bi-weekly per our reputed company payroll practices. Final reputed company pay reputed company are dependent upon a reputed company of factors which may include, but are not limited to: reputed company set, years of relevant experience, education, location, and licensure/certifications.OUR COMMITMENT TO EQUAL OPPORTUNITY EMPLOYMENTDiversity, inclusion, and belonging are at the core of reputed company’s values. We are an equal opportunity employer. We enthusiastically accept our responsibility to reputed company employment reputed company without reputed company to race, religious creed, reputed company, age, sex, sexual orientation and identity, national reputed company, citizenship, religion, marital status, familial status, physical, sensory, or medical disability, Family and Medical Leave, military or veteran status, pregnancy, childbirth or other reputed company 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 DATAThis position is responsible for following reputed company reputed company policies and procedures in order to protect reputed company PHI and PII under reputed company’s custodianship as reputed company as reputed company Intellectual Properties. For any reputed company-specific roles, the responsibilities would be reputed company defined by the hiring manager.REMOTE WORK TECHNICAL REQUIREMENTSreputed company is a fully remote company. We reputed company new employees with the necessary equipment to function in their role at no charge to the employee. Employees reputed company their own internet reputed company, capable of conducting video calls on camera and connecting to various reputed company systems. The required internet speed is a minimum of 50 mbps download, 10 mbps upload. Please consult with your internet provider or run a speed test to confirm your internet reputed company meets these requirements. Apply for the job now! Apply for this job