Manager (RN) - Population Health Medical Management & Care Management

York, PA | Professional | Tracking Code: 58810a

Position Summary:

General Summary:
Under the general supervision of the Regional Director of Case Management Operations/Population Health, supervises and oversees the work activities of the medical management and care management teams. Works in a team leadership model to develop and maintain operations that are consistent with Hospital, Medical Group, Population Health, System and community needs. Provides direction to staff regarding utilization management and care management population management, social services. Manages both the centralized and the regional teams throughout the health systems service areas. Provides input into the budget management of resources and works collaboratively with leadership to oversee the operational activities of the department.


Duties and Responsibilities:

Assists with planning, organizing and directing the implementation of Population Health Utilization Management and Care Management teams. Ensures staff is properly trained, oriented and provided with regular professional development. Identifies opportunities for improvement, both clinical and administrative, and assists the Director in the strategic planning processes for these functions.
In conjunction with Director, coordinates and implements the development of recommended policies and programs. Coordinates, establishes and monitors achievement of departmental goals and objectives. Responsible for achievement of assigned NCQA standard compliance and compliance with all applicable State and Federal laws, as well as achievement of assigned incented health outcomes.
Ensures effectiveness of existing programs and services, identifies and evaluates new programs and services to address cost effectiveness through improving patient care and health outcomes while reducing inappropriate hospitalizations and other unnecessary costs, proposed process improvements and to achieve compliance with NCQA and State incented health outcomes.
Supervises and manages a team of Utilization Management Nurses and Ambulatory Collaborative Care Team members.
Assists with the operations management, oversight and performance monitoring of ongoing subcontractor/vendor partnerships. Responsible for the identification, development, communication and management of performance improvement activities related to subcontractor/vendor services or operational processes.
Participates in and supports the corporate Population Health Strategy.
Ensures the coordination of positive inter and intra communication to share information regarding quality of care, member issues and cost effective services. Works across departmental lines to achieve objectives.
Creates and supports an environment that fosters teamwork, cooperation, respect and diversity. Establishes and maintains positive communication and professional demeanor with employees, providers and acts as liaison with outside entities as required. Demonstrates and supports commitment to corporate goals and mission.
Engages with staff to develop lean daily management process to access opportunities for improvement and empowers team to address. Conducts employee/ leadership rounding with staff to identify and resolve barriers for staff.


Department Description:

WellSpan Population Health Services provides coordination of health benefits offering a Preferred Provider Organization supporting accountable care and medical management which includes case management and utilization management. WellSpan Population Health Services is committed to provide care in compliance with the WellSpan triple aim: to improve the cost, quality, and patient experience in an efficient and effective delivery system for patients and providers.
 
Required Skills

Active PA RN license required

Bachelor's Degree required

3-5 years supervisory experience

Lean daily management/quality improvement experience preferred

Certified case manager within 2 years of hire

Required Experience

Must have accountable care and/or payor utilization management and care management experience


Quality of Life

WellSpan Health is an integrated health system that serves the communities of central Pennsylvania and northern Maryland. The organization is comprised of a multispecialty medical group of more than 1,500 physicians and advanced practice clinicians, a regional behavioral health organization, a home care organization, eight respected hospitals, more than 19,000 employees, and 170 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.

Quality of Life
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)

Equal Opportunity Employment

WellSpan Health is an equal opportunity employer. Employment selection and related decisions are made without regard to sex, race, age, disability, religion, national origin, color or any other protected class. WellSpan Health does, however, have a tobacco-free/nicotine-free hiring policy.

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