Clinical Case Manager, RN

Benefits

Additional Information

Job Description Summary ‎ The ACO Clinical Manager 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 lead ACO clinical initiatives. This includes but is not limited to case management, discharge planning, 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 well as the ability to utilize both internal and external resources to accomplish the goals and objectives of the organization. ‎ How will you make an impact & Requirements ‎ Hours Monday-Friday 8am-5pm-Full-Time This is a traveling role- 3 days a week to offices in Melbourne/Vero Beach 2 days will be working from home (schedule can vary) Essential Duties and Responsibilities include the following. Other duties may be assigned. - Effectively manage day to day ACO/MA Plan Clinical Programs to enhance clinical efficiencies - Identify opportunities for increased outpatient vs. inpatient utilization - Utilizes data provided to help in managing population health needs and implements population programs for ACO/MA Plan beneficiaries - Execute case management for patients identified at highest risk for adverse event or exacerbation having ability to impact, with goal of decreasing unnecessary emergency department visits/hospitalizations - Oversee extended patient care team including but not limited to: Social Workers, Emergency Department Liaisons, Behavioral Health Liaisons, and Home Health Liaisons. - Oversee smooth Transitional Care Management for all 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/social services are provided as indicated. - Ensure Quality Measures are reviewed and addressed when applicable/appropriate - Implement and direct ACO/MA Plan Health Education Activities for beneficiaries, providers, and staff Human Resources Job Description: Community Outreach Liaison Rev. 8/15/17 - Participate in Care Coordination and Quality Committees, Primary Care Provider POD Meetings, Hospitalist POD Meetings, Hospital Joint Operation Meetings, JOC Meetings, and other meetings as required - Monitor corporate initiatives and strategies to achieve utilization of business and financial goals - Manage the successful integration of ACO Programs into current operations to meet the goals of all stakeholders - Maintain collaborative relationships with business partners both within the company and the community - Manage and execute organizational opportunities and implement changes that are in alignment with corporate financial goals and strategic endeavors. Competencies To perform the job successfully, an individual should demonstrate the following competencies: Analysis/Problem Assessment - Securing relevant information and identifying key issues and relationships from a base of information; relating and comparing data from different sources; identifying cause-effect relationships. Compassion - The responsibility to put a patient's or person's interests first, including the duty not to harm, deliver proper care, and maintain confidentiality. Compliance - Employee has satisfactory completed employers required compliance training. Employee is able to demonstrate an understanding of employers Code of Conduct. Communication - Expressing ideas effectively in individual and group situations (including nonverbal communication); adjusting language or terminology to the characteristics and needs of the audience. Good listening skills. Dependability - Meets commitments, deliverables, deadlines, work independently, accepts accountability, handles change, sets personal standards, stays focused under pressure, and meets attendance/punctuality requirements. Individual Leadership/ Influencing - Using appropriate interpersonal styles and methods to inspire and guide individuals (fellow employees) toward goal achievement; modifying behavior to accommodate tasks, situations, and individuals involved. Innovation - Generating creative solutions to work situations; trying different and novel ways to deal with organizational problems and opportunities. Integrity - Maintaining and promoting social, ethical, and organizational norms is conducting internal and external business activities. Judgment/ Problem Solving - Recognizes problems and responds, systematically gathers information, sorts through complex issues, seeks input from others, addresses root cause of issues, makes timely decisions, can make difficult decisions, uses consensus when possible, and communicates decisions to others. Maximizing Performance - Establishing performance/development goals, coaching performance, providing training, and evalu