RN Manager of Case Management & Population Health – TPA
RN Manager of Case Management & Population Health Job Summary:
Responsible for providing administrative and clinical leadership and oversight of the Population Health Management staff to ensure successful delivery of complex case management, condition management, care transition and care coordination services.
Responsible for the daily operations and productivity of staff, daily problem-solving of clinical and operational issues, and the development and revision of policies and procedures.
Assists in relationship-building with health care venues across the care continuum to ensure coordinated care.
Provides oversight, direction, leadership and mentoring to staff functioning in complex case management, condition management, care transitions and care coordination, ensuring that standards of practice are met during encounters with patients, families/caregivers, community resources and in compliance with delegation requirements from payors.
Reviews population health reports, patient care assignments and case load to promote optimal productivity and efficiency.
Monitors staff documentation, performance goals and standards.
Establishes, implements and maintains policies, procedures and processes to provide for effective and efficient care, condition management, care coordination and care transitions.
Conducts regular audits of staff performance against standards and ensures compliance with delegation requirements from payors.
Maintains records and data for care programs to ensure trending of optimal outcomes and goals
Works collaboratively with data analysts to develop clinically oriented outcomes reports.
RN Manager of Case Management & Population Health Background:
Valid, unrestricted state Registered Nurse (R.N.) license.
Bachelor of Science in Nursing (B.S.N.) or related field preferred; Master’s degree a plus.
Certified Professional in Healthcare Quality (CPHQ) is highly preferred.
Roughly 5 years of recent acute care clinical nursing experience, ideally including in provider clinic setting.
At least 2-3 years of experience in Care Coordination and/or Population Health Management, including managing chronic disease patients, is required.
Around 2 years of management or staff supervision within a managed care or hospital environment.
Resourcefulness as demonstrated by the effective application of professional knowledge to new situations.
Possess planning, organizing, conflict resolution, negotiating and interpersonal skills.
Experience in training, teaching, and coaching staffs to meet operational requirements and goals.
Strong oral and written communication skills; ability to interact with all levels of internal and external contacts.
Must be able to prioritize, plan, and handle multiple tasks/demands simultaneously.
Must be willing and able to travel in area, if needed (infrequent).