Director (RN) - Population Health Case Management

York, PA | Professional | Tracking Code: 74147

Job Description:

Under the general supervision of the Director-Corporate Case Management, oversees the development and management of various care management programs that support the System’s population health strategy. Oversees the medical management staff who perform utilization management, complex case management, and the system intake center (administrative hub) for care management programs. Serves as the key leader for medical management operations for the System’s Third Party Administrative services and accountable care relationships with other payers. Collaborates with System entity clinical and operating and Service Line leadership to develop and implement innovative care management operations that support the System’s Population health strategy. Provides oversight of performance of care management programs. Employs direct communication, site visits, information distribution, staff education and problem solving to develop relationships, obtain feedback, share news and help post-acute providers understand and meet the System’s requirements. Coordinates with Population Health Leadership regarding community resources and specialty services.

 

Duties and Responsibilities

  1. Assists in developing innovative case management programs including telemedicine case management. Works with the System’s Service Lines, Health System, and Medical Home leaders to develop and implement disease/care management programs that enhance patient self-management of chronic illnesses.
  2. Supports the implementation of and provides operational support for the System’s post-acute care strategies.
  3. Coordinates and implements strategies with System clinical operations with the primary goal of enhancing clinical management and increasing referrals to the System’s clinical programs and services in the post-acute phase of care.
  4. Collaborates with clinical operations, IT, Population Health Services staff, System leadership and others to ensure the accuracy and integrity of referral processes, transitions of care and data profiles of post-acute providers.
  5. Uses data to establish metrics, monitor utilization trends required in an Accountable Care Organization (ACO) business model including referral trends and performance and reports on the overall effectiveness of the post-acute providers.
  6. Makes staffing recommendations and oversees the reporting responsibilities of medical management clients including WPN network, reading the key functions of Medical Management and disease management, utilization trends, case management and medical management operations.
  7. Develops and manages a robust complex case management function that supports the developing ACO model, including appropriate quality controls/assessment programs for the medical management functions.
  8. Establishes and maintains ongoing communications with post-acute services, referring physicians and their leadership staffs, including routine contact follow-up visits, phone calls and visits.
  9. Measures and evaluates liaison activities including producing and sharing regular summaries of visits and their outcomes as well as their impact on referral trends.


 

Qualifications

  • Minimum Experience:
    • 5 - 8 years experience working in management in health care industry
  • Minimum Education:
    • Bachelor's Degree in Nursing
  • Minimum Field Of Expertise:
    • Case Management, Health Plan with Medicare/Medicaid experience preferred
  • Preferred Education:
    • Master’s Degree in Health care related field
  • Required Certification:
    • Registration and current RN license in PA
Heather Torres
Heather Torres
Sr. Talent Acquisition Consultant
Best of the Best Awards
Similar Opportunities
Share

Why WellSpan Health?

WellSpan Health is an integrated health system that serves the communities of central Pennsylvania and northern Maryland. The organization comprises a multispecialty medical group of more than 1,600 physicians and advanced practice providers, a regional behavioral health organization, a home care organization, eight respected hospitals, more than 20,000 employees and 200 patient care locations. WellSpan is a charitable, mission-driven organization committed to exceptional care for all, lifelong wellness and healthy communities. We are committed to transforming the health of the communities we serve and to educating the next generation of clinicians, staff and leaders.

Employment Benefits

  • Sign-on incentives for new employees (click here for details)
  • Medical, dental and vision insurance
  • Life and accidental death insurance
  • Supplemental life insurance
  • Retirement savings plan
  • Paid time off (PTO)
  • PTO bridging
  • Short-term disability
  • Educational assistance
  • Forgivable loan
  • Flexible spending
  • Credit union
  • Employee recreational activities
  • Childcare
  • Complimentary medicine discounts

Diversity & Inclusion

Welcome. Respect. Value.

Wellspan Health believes that diversity includes all the human characteristics that make each of us similar as well as different. We strive to make every person feel welcomed, respected, and valued while creating a safe and inclusive environment where we all have the individual freedom to express our uniqueness in a respectful manner.

WellSpan Health is an Equal Opportunity Employer. It is the policy and intention of the System to maintain consistent and equal treatment toward applicants and employees of all job classifications without regard to age, sex, race, color, religion, sexual orientation, gender identity, transgender status, national origin, ancestry, veteran status, disability, or any other legally protected characteristic. WellSpan Health does, however, have a tobacco-free/nicotine-free hiring policy.

Quality of Life

Founded in 1741, the city of York is considered by many as the first capital of the United States. The Articles of Confederation were signed by the Second Continental Congress here in 1777. Its beautifully restored historic district is an architectural treasure. While York retains its farming and manufacturing heritage, at its heart York is a thriving cultural community that has attracted creative talent and innovative entrepreneurial investors from across the nation.

Life in York County offers affordable housing, options for higher education, a thriving arts and cultural community, historical attractions, parks and recreational resources, semi-professional baseball team, fine dining and more — within an easy drive of major East Coast cities.

York County residents can find local employment in healthcare, manufacturing, technology, agricultural and service sectors. (Patient population: 445,000)