Provides administrative oversight and monitoring of the Chronic Care Management (CCM). Advise professional nursing staff performing telephonic chronic care patient management functions ensuring that patients receive care and services that meet all contractual and regulatory requirements for quality, timeliness and appropriateness. Works with the nursing staff for escalation of care remedies.
Duties and Responsibilities:
Develop and implement appropriate processes to facilitate effective chronic care patient management.
Develop protocols, processes and SOPs for the Chronic Care function.
Provide management of the Chronic Care clinical escalation process for the CCM team related to healthcare delivery.
Ensures team is meeting contractual obligations and program SLAs.
Participate in strategic and tactical planning sessions
Make recommendations to Medical Director and Chronic Care Management leadership for improvement of processes and services.
Participate in client presentations with sales representatives as the subject matter expert related to the Chronic Care Management business.
Ensure adequate and timely care review documentation, document preparation and maintenance.
Participate in all contractual and regulatory audits involving the department.
Make recommendations in the development of long-term strategies.
Present strategic and operational plans for the development of new capabilities.
Involved with the development of policies, standard operating procedures and work instructions.
Oversees the recruitment, training and management of CCM teams.
Performs related duties as assigned
Graduated from an accredited school of nursing with licensure as RN
Bachelors of Science Nursing required, Masters of Science Nursing or Master’s Degree preferred
Requires broad knowledge, training, and protocol/SOP development in the field of healthcare.
7-10 years professional experience managing patient care, ideally in a primary care or urgent care setting.
Work in a nurse outreach call center environment, preferred.
Experience in the chronic care management or home health is a plus
General knowledge of chronic care patient management; and operational policies and processes
Physical and Mental Requirements:
While performing the duties of this job, the employee is regularly, required to communicate in person and on the telephone.
The employee is frequently required to use hands to finger, handle, or feel in order to operate computer keyboard, office equipment and other essential tasks.
This position infrequently lifts, carries or otherwise moves and positions objects weighing up to 25 pounds.
Maintain composure under pressure; adapts to change; ability to grasp information quickly.
Ability to multi-task, Analytical skills, Ability to follow verbal or written instructions,
Strong customer/client management background
Strong project management skills with experience in organizing, planning and executing projects from vision through implementation
The ability to manage multiple tasks along a parallel process
Strong decision making capabilities
Critical thinking skills, creative and innovative solutions to internal or external client needs
Strong industry knowledge
Strategic thinker with long term planning experience
Ability to communicate effectively both orally and in writing
Possess strong interpersonal and leadership skills, be able to develop and grow talent
Strong organizational agility, be able to manage team through change and lead by example
Ability to proficiently use computer and good knowledge of Microsoft Office