Attends Care Management Meetings, Participates in patient satisfaction programs as required and follows up on all inpatient/outpatient discharges, Assists the Center Medical Director with the management of high-risk patient populations and appropriate Care management plans, 1-2 years of previous care management, utilization review or discharge planning experience is preferred, Ability to perform accurate telephonic triages, accurately record findings with follow-up, Knowledge and skill in the applications of the techniques and practices of the nursing profession, Ability to explain medical instructions to patients and their families, Ability to be a clinical resource for non-licensed office staff, Ability to prioritize and multi- task in a high paced environment with good organizational skills, Display initiative, accountability and resourcefulness, Coordinate the member care, services and health benefits with members and their healthcare providers across the continuum of illness, Collaborate with members of an inter-disciplinary team to meet the needs of the individual and the population, Maintain current and accurate documentation of enrollment in care management program, Maintain appropriate and timely documentation of care plans, case notes, referrals, assessments and other pertinent information in documentation system, Assist in education of members and Health Partners regarding healthcare access and benefits, and provide them with health education and wellness materials, Maximize the member’s health, wellness, safety adaptation and self-care through effective care coordination and case management, Participate in meetings with Health Partners to inform them of Lock-In Program and case management services and benefits available to members, Facilitate coordination, communication and collaboration with stakeholders in order to achieve goals and maximize positive member, Three to five (3 to 5) years of experience in nursing, social work or in a healthcare (discharge planning, case management, care coordination and/or community/home health) environment is required, Five (5) or more years of clinical experience is preferred, Three (3) or more years of Medicaid/Medicare is preferred, Intermediate proficiency level with Microsoft Office Suite to include Outlook, Word and Excel, Ability to communicate effectively with a very diverse group of individuals, Ability to operate a smart phone, iPad, or other technical equipment to ensure productivity & ability to perform essential functions, Knowledge of local, state and federal healthcare laws, regulations and environment, Awareness of community and state support resources for population served, Effective listening and critical thinking skills, Adhere to code of ethics that aligns with professional practice, Bachelor’s of Science in Nursing (BSN) preferred, Three to five (3-5) years of experience in nursing, social work, or healthcare field (discharge planning, case management, care coordination, and/or home/community health experience) is required, Five (5) years or more clinical experience is preferred, Collaborate with team members to optimize outcomes for members, Knowledge of local, state & federal healthcare laws and regulations & all company policies regarding case management practices, Strong advocate for members at all levels of care, Proven track record for improving processes to make things easier for those you have served, Determine member and/or caregivers needs regarding financial supports, social supports, psychological supports, and counseling; provide information and referral, Practice and adhere to departmental and state guidelines, Managed care experience; must be able to comply with and understand complex organizational, State, and Federal guidelines, Must be NYS licensed as a Registered Nurse, Assess and evaluate member needs by using various data tools and resources, Assist members and their families in the administration of their health plan benefits, promote medication compliance, align with healthcare professionals, as well as assist in shared decision-making, Collaborate within a team of professionals (supervisors, managers, account representatives, member service associates, and physicians) to provide care coordination appropriate for members, Interpret and apply case management criteria, processes, policies, and regulatory standards, Interact with treatment providers, PCPs, and physicians as needed to support the plan of care, Monitor for clinical quality concerns and refers appropriately, Ability to adapt and be flexible to change, Ability to analyze information to construct effective solutions, Execution and results (ability to set goals, follow processes, meet deadlines, and deliver expected outcomes with appropriate sense of urgency), Cultural competence (demonstration of awareness, attitude, knowledge, and skills to work effectively with a culturally and demographically diverse population), Clinical assessment (ability to interpret, evaluate, and clearly document complex medical information using a directive and focused approach in order to identify relevant and actionable conditions, circumstances, and behaviors), Care planning (ability to identify and clearly document member-driven, specific, measurable activities that address actionable conditions, circumstances, and behaviors in order to improve health outcomes and cost-effectiveness of services), Member collaboration and engagement (ability to secure and maintain the motivation, participation, and collaboration of all relevant parties in a purposeful plan to improve health outcomes and cost-effectiveness of service delivery, Oversee the clinical aspects of Care Coordination as delivered by a pod of Intake and Assessment specialists and Care Coordination staff, which includes review and sign off of assessment of the behavioral health, psychosocial and medical needs of identified members, Oversee and approve clinical aspects of the creation of a person centered and culturally competent Individualized Care Plans (ICP) to include problem identification, goal-setting in collaboration with members, community based behavioral health providers, primary care physicians and other interdisciplinary care team members to develop a comprehensive and integrated approach to care coordination interventions and expected outcomes, Develop and/or oversee the ICP for each member in collaboration with all team members, adhering to timelines and including assessment of health needs, individualized care management plans, implementation, monitoring and evaluation of care outcomes, Oversee clinical aspects of the Interdisciplinary Care Team (ICT) to ensure that the member goals are being addressed from a treatment team approach and collaborating with the team to complete care plan updates as required, Ensure member crisis plans are comprehensive and provide clinical oversight on behavioral health crises and emergencies as needed, Excellent clinical skills with a proven ability to provide clinical supervision to non-clinicians, Ability to prioritize and manage multiple tasks simultaneously while meeting deadlines for deliverables, Excellent written, oral and presentation skills, Strong organization skills, ability to multi-task, ability to manage multiple priorities and work collaboratively within a team environment, Must be detail oriented; able to work independently in an ever changing environment, Minimum 5 years nursing experience in managed care and/or hospital settings working with patients with chronic disease states (e.g. Contact the participants' PCPs as necessary to support the member in the disease management program, Corporate Disease Management – Provide DM services for all programs - CA, UT, WA, MI, NM, TX, OH, MO, FL, WI, Bachelor's degree in health education or other related health science fields, At least two-years experience conducting patient teaching related to chronic disease within an acute facility, ambulatory medical group practice, or community outpatient clinic required, At least one- year experience working with culturally diverse and low-income populations, Managed care experience is highly desirable, Minimum: At least 1 year of recent clinical experience, Preferred: 3 to 5 years of recent clinical nursing experience, Thorough understanding of LVN scope of practice, Bachelor's Degree in related field required, Certified by the National Association of Catholic Chaplains or College of Chaplains preferred but not required, Two(2) years of related work experience preferred, Case management and discharge planning experience, Experience working in the field highly preferred, Respond to member’s crisis by providing crisis counseling, refers to providers or community resources to assess member needs, and reviews requests for service authorizations for designated services, Provide prior authorizations, peer reviews and referrals to facilities, providers and group practices and other services as appropriate, Provide comprehensive evaluation and treatment planning by providing concurrent reviews and discharge planning for continuity of care to members, Present and review cases with the Medical Director and Associate Medical Directors to promote member treatment and after care, Assists with education and collection of data for HCC coding and STARS/HEDIS measures, Identifies members to refer to Disease Management and /or High Risk Programs, Ability to establish and maintain effective working relationships with Health Plans, and local personnel, Has 2 years nursing experience or 1 year of Hospice experience, Responsible for the direct supervision of the transitions team including clinical and non-clinical staff, Provides clinical oversight and supervision to non-registered nurse staff, Works in conjunction with the Manager of Care Management on training and team development, Designs transition of care plans with the patient. Proposes alternative plans of treatment when requests for services do not meet medical necessity criteria. … Work requires sitting for extended periods, talking on the telephone and typing on the computer, Typical office working environment with productivity and quality expectations, Develops, coordinates and implements clinical care management through partnership with Social Work Care Manager and Care Management Assistant in collaboration with clinical leadership, physicians, nursing staff, and other interdisciplinary clinicians, Participates in psychosocial management of patients, Facilitates plans for the transitions of patient care to the next level and location of care, Partners with system care navigation resources and care navigators from other settings to provide continuity of care and effective transitions, Maintains accountability for utilization management and communication with payers to assure continued stay authorization and assists with financial activities affecting the hospital stay, Conducts review activities on a daily basis following InterQual guidelines, Performs concurrent reviews to respond to payers, Registered Nurse with current Minnesota license, Associate's degree from an accredited school of Nursing required. Advocating for individual needs as indicated; 5.3. and identify opportunities for further engagement, Monitor progress in accounts and evolve action plans as appropriate (contacts, plan execution, volume growth, and market share); Manage overall commercial performance of accounts, Align budgets and resources to account(s) in a way that optimizes return on investment, Partner with local representatives and DMs to ensure pull-thru and progress of the plans and goals built for the surrounding communities of the ECE, Accountability and adherence to corporate, FDA, and PDMA guidelines, BA/BS Degree required; MBA or advanced degree in a related field preferred, 7-10 years of previous specialty pharmaceutical, biotech, or medical marketing/sales and account management experience required, Experience managing major accounts and understanding influence patterns, and previous IDN/Health System selling experience in local area required/highly preferred, Understanding of integrated health system operations and integrated care delivery models, including economics, supporting processes and behaviors, Knowledge of IDN needs, population health management, ACOs, and risk-based payment models; Understanding of the application of HEOR, Understanding of the processes for developing formularies, protocols, and order sets, and how they are used to influence treatment decisions at the physician level, Thorough clinical understanding of the epilepsy therapeutic area preferred, including in-patient and out-patient care management, Ability to develop and manage relationships, and tailor communications to a variety of audiences in both a B2B and clinical context, especially at C-Suite level (e.g., executive presence). Performs miscellaneous duties as required or requested, Collaborates with multiple departments within UPMC (e.g. There are over 179 idd case manager … ), Recruit, develop, train, coach, assess, motivate and retain talent to achieve Neurology portfolio goals, Develop and present in conjunction with the NICM sound clinical, pharmaco-economic and business presentations to appropriate customers based on mutual needs/benefits, Maintain open communication throughout the organization by partnering with relevant cross functional departments to provide leadership and insights that lead to strong relationships and the development of appropriate business strategies that support brand(s) objectives in ECE accounts, Review and analyze product performance at the regional level and communicate account performance broadly with key internal stakeholders, 7-10 years of previous pharmaceutical, biotech, or medical marketing/sales and account management experience required, Experience managing major accounts and understanding influence patterns, and previous IDN/Health System selling experience in geographic area highly preferred, A minimum of 4 - 5 years successful experience leading and coaching teams in the pharmaceutical industry (within IDN’s, Epilepsy Centers preferred), Understanding of integrated health system (IDNs) operations and integrated care delivery models, including economics, supporting processes and behaviors. This includes intakes from outside referral sources and consult from other departments within the hospital (i.e. 9.1. 3.4. Verifies that beneficiary meets ECHO criteria. Interacts with providers in a professional, respectful manner that facilitates the treatment process, Performs concurrent reviews for inpatient care and other levels of care as allowed by scope of practice and experience. Collaborates with other departments to accelerate scheduling and to facilitate access to tests and consultations. Leave a Reply Cancel reply. 972 Idd Program Manager jobs available on Indeed.com. (for RNs: BSN strongly preferred; new grads must have BSN), 3 years of clinical experience strongly preferred; Case Management experience preferred, Provide coordinated care management services to persons with psychiatric disabilities and other chronic behavioral and physical health conditions in accordance with agency/SBU, NYS OMH, NYS DOH, Health Home, Suffolk County DMH and Medicaid guidelines and regulations, policies and procedures, Care Management services are provided to clients in the field which requires use of one's own vehicle for travel to/from appointments and for transporting clients as necessary, Perform Health Home services and support agency clients in the development and fulfillment of life and recovery goals in an individual and group format, Assist clients to improve health outcomes and to increase independent control over their lives and become active and contributing members of their community, Complete required client and program record keeping and documentation in accordance with professional standards and the guidelines and regulations stipulated by the NYS DOH Health Home Initiative, the NYS OMH Suffolk County Division of Community Mental Hygiene and the Office of Compliance and Audit for SBU, Develop systematic and comprehensive knowledge of client rights and entitlements, community, behavioral and physical health, other resources and referral and grievance procedures, Develop practices in accordance with the advocacy/empowerment theoretical model, operating from a client-centered, strengths and recovery-based social work practice orientation, Develop necessary education and skills to assume the role of the Care Manager in the Medicaid Health Home Initiative, Participate in outreach activities to potential and former clients, Provide health education to client community and take leadership in implementing community based programs and initiatives and advocacy-oriented projects, to organize and educate others on health and recovery oriented issues and obstacles faced by client population, Attend required and recommended component, staff, in-service and web-based training, meetings and activities, Participate in critical reflection of one's practice and provide feedback and support to staff and colleagues, Perform other duties and responsibilities assigned by the agency Director and in specific those necessary for the successful conversion of the agency's case management program to the Medicaid Health Home Initiative, Interact with all levels of nursing and other departments to assure effective utilization of resources meet the physiological and safety needs of the patient and their families, Coordinate the transfer of patients as instructed by the Medical Director or PCP, Contact RN/Social Worker at the hospital or facility receiving the patient, to communicate plan of care, Arrange direct admissions to hospitals and placement in nursing homes. Program Manager of IDD Authority Services Job Code: PRMGR - 122 Revision Date: Dec 21, 2018 Salary Range: $27.22 - $44.54 Hourly $2,177.60 - $3,563.20 Biweekly $56,625.00 - $92,633.00 Annually FLSA: Exempt Overview We are an agency committed to innovative behavioral health services in trauma-informed care … Care On The Go Mobile Healthcare Services; Orlando, FL. Understanding of the market access and reimbursement landscape, hospital buying process, hospital contracting process, Entrepreneurial nature and ability to think strategically and creatively to influence, meet, and adapt to changing customer needs, Demonstrated ability to develop account budgets and conduct account sales analysis, Ability to effectively collaborate with a variety of stakeholders, internal and external to the organization, Ability to meet the travel requirements of the role based on assigned ECE’s, Lead their NICM team in deriving, validating, and leveraging customer and account insights on a regular basis. Those interested in a Residential Supervisor job should be able to demonstrate the following skills in their resumes: home care expertise, leadership, organization and planning, attention to details, effective communication, and customer service orientation. Contribute to the development and achievement of the project goals and objectives, and continually evaluate processes to ensure that services are delivered in an effective and culturally competent manner, Systematically screen patients for depression and unhealthy substance use using evidenced based screening instruments assigned by the project, The clinical care manager will assure that direct service staff meets funding source requirements, monitor productivity/case load, track no shows/cancellations, as well as all outside referrals, and continually assess, and revise service delivery processes as needed to assure payment for services, The clinical care manager will be invested in his/her own professional development by reading, attending appropriate conferences, and taking the initiative to be informed of developments and changes in the field, the results of recent studies, national standards, and the activities of similar organizations, The clinical care manager will directly supervise the LCSW staff at each of the three health centers. 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