Details: As a patient-focused organization, the University of Utah Health Care exists to enhance the health and well-being of people through patient care, research and education. Success in this mission requires a culture of collaboration, excellence, leadership, and respect. University of Utah Health Care seeks staff that are committed to the values of compassion, collaboration, innovation, responsibility, diversity, integrity, quality and trust that are integral to our mission.This position is responsible for planning, organizing, directing and controlling all aspects of the assigned department's internal and external customer service, human resource and financial management operations. The incumbent acts as a catalyst between the department and its customers and staff to ensure continuity and quality of service and care.Responsibilities:JOB SUMMARYUniversity Health Plans is a Managed Care Organization which manages the healthcare of University of Utah employees, Utah Medicaid recipients, members of Healthy Advantage Medicare, and the UNI Behavioral health plan of a variety of other groups. We serve approximately 126,000 members across 10 counties in Utah.The Care Management Manager will be the manager of a dynamic Care Management program, focused on reaching national best practices and serving the needs of the community in which we live. This position provides management and leadership of the Case & Disease Management, Utilization Management, Clinical Quality Assurance & patient engagement programs to impact population outcomes while meeting all State, Federal and Accreditation requirements.The selected candidate will play a critical role in managing our efforts of transformation into a new way of service delivery and care coordination by:• Managing the staff of nurses and coordinators – current tasks and as they change• Using multiple sources of member data and standards of care to generate predictions about a member’s future health need/risks• Managing interventions to prevent or minimize impact of disease based on need/risk• Customizing and integrating programs to meet the member’s unique needs• Creating new opportunities for members to actively take part in their own health choices about illness and well being.QUALIFICATIONS• 5+ years experience in a management or supervisor level of case/utilization/disease management• Clinical licensure preferred• Progressive responsibilities and accountabilities in leadership roles• Bachelors or Masters degree in a Healthcare related field and• Medicare/Medicaid experience highly desirableESSENTIAL KNOWLEDGE AND SKILLS• Working knowledge of case management, disease management and health promotion principles and processes• Comprehensive knowledge of healthcare principles and practices, including a basic knowledge of clinical medicine and familiarity with common medical and behavioral health conditions of adults and children• Familiarity with government regulations on healthcare plans and patient care• Strong leadership and proven management skills• Demonstrated creativity, flexibility, sound judgment, and ability to take initiative• Strong communication and writing skills and demonstrated ability to interact professionally with culturally and educationally diverse staff and plan members• Supports implementation of overall strategic plan and development in order to achieve ACO financial and organizational goals.• Oversees the planning, assessing, monitoring and managing of plan member care to ensure that they receive quality care in the most cost effective manner.• Directs the workflow of care managers, utilization managers, and coordinators, and develops departmental policies and procedures.• Uses reporting functions to monitor performance of the team, contractual standards, and internal and external quality measures.• Manages program standards & procedures to monitor their impacts on the health, experience, and cost of care for plan members, and addresses needed changes.• Develops new initiatives that will enhance plan performance, including reduction in unplanned acute care hospital events, improvement in HEDIS scores, and other standardized health metrics.• Interacts with Provider Network team and other areas to ensure coordinated approach and support for each team’s initiatives and communicates consistent messages in all interactions.• Collaborates with physicians and medical staff to ensure member expectations are being met.• Acts as a resource for staff on decision making and problem solving; encourages staff growth, education, and retention; and supervises care management supervisory staff.• Facilitates Medical Director and care coordination interaction and problem solving.Qualifications:Required• Bachelor’s degree in a related area of assignment or equivalency.• Four years or more progressively responsible management experience.Qualifications (Preferred):Preferred• Medicare / Medicaid experience• 5+ years in quality, utilization, case and disease management• 5+ years in a management or supervisory level of case/utilization/disease management• Clinical licensure preferredmnstrcbuilder
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