Manager, Clinical Care - Remote

Guidehealth; Dallas (TX); Remote; USD 80,000 - 120,000; Full time

Job summary

A leading health organization is seeking a Manager for Clinical Care in Dallas, responsible for overseeing clinical programs and managing staff to enhance care coordination and quality initiatives. The ideal candidate will demonstrate strong leadership, manage a multidisciplinary team, and engage in community partnership activities to meet organizational goals.

Qualifications

• Strong leadership and management capabilities.
• Experience in clinical care management.
• Strong interpersonal and communication skills.

Responsibilities

• Manage day-to-day Health Plan Clinical Programs.
• Oversee case management for high-risk patients.
• Ensure quality measures are reviewed and addressed.

Skills

Leadership

Interpersonal Skills

Management

Data Analysis

Job description

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Job Description

The Manager, Clinical Care is primarily responsible for the day-to-day operations of an integrated multi-disciplinary clinical and clinical support structure that will effectively monitor, support, and lead Value Based clinical initiatives. This includes but is not limited to case management, transitions of care, care coordination and continuity, provider/staff education on ACO/MA Plan clinical programs, and helping to build and maintain a network of community support. This individual must exhibit strong leadership, management, and interpersonal skills, as well as the ability to utilize both internal and external resources to accomplish the goals and objectives of the organization.

Job Description

The Manager, Clinical Care is primarily responsible for the day-to-day operations of an integrated multi-disciplinary clinical and clinical support structure that will effectively monitor, support, and lead Value Based clinical initiatives. This includes but is not limited to case management, transitions of care, care coordination and continuity, provider/staff education on ACO/MA Plan clinical programs, and helping to build and maintain a network of community support. This individual must exhibit strong leadership, management, and interpersonal skills, as well as the ability to utilize both internal and external resources to accomplish the goals and objectives of the organization.

What You’ll Be Doing

Effectively managing day to day Health Plan Clinical Programs to enhance clinical efficiencies

Identifying opportunities for increased outpatient vs. inpatient utilization

Utilizing data provided to help in managing population health needs and implement population programs for Health Plan beneficiaries

Executing case management for patients identified at highest risk for adverse event or exacerbation, having the ability to impact, with the goal of decreasing unnecessary emergency department visits/hospitalizations

Overseeing an extended patient care team as assigned including but not limited to:Social Workers, Emergency Department Liaisons, Behavioral Health Liaisons, and Home Health Liaisons.

Overseeing smooth Transitional Care Management for all patients discharged from in patient facility (hospital, skilled nursing/rehab, behavioral health) ensuring: Primary Care Provider visit, DME and Home Health Services, Specialist appointments, and community resources/social services are provided as indicated.

Ensuring Quality Measures are reviewed and addressed when applicable/appropriate

Implementing and directing Health Plan Health Education Activities for beneficiaries, providers, and staff

Participating in Care Coordination and Quality Committees, Primary Care Provider Meetings, and other meetings as required

Monitoring corporate initiatives and strategies to achieve utilization of business and financial goals

Managing the successful integration of ACO Programs into current operations to meet the goals of all stakeholders

Maintaining collaborative relationships with business partners both within the company and the community

Managing and execute organizational opportunities and implement changes that are in alignment with corporate financial goals and strategic endeavors.

Managing departmental expectations: staff hiring, orientation, auditing, and reviews; time management; motivation; and performance improvement

Prioritizing of data, tasks, and requirements: Project management with expertise in departmental tasks and processes

Representing for health plan audits with development of actions plans for individual clients as needed to ensure compliance and incentive payouts

Overseeing all projects, productivity, daily tasks and PHM activities in an organized and efficient manner

Ensuring access to EMR systems for department staff

Monitoring staff maintenance of HIPPA regulations

Communicating with health plan contacts, customer Administrators and Client Business Managers to ensure resolution of any concerns.

Identifying and disseminating of Health Plan announcements applicable to Case Management

Seniority level

• Seniority level

  Mid-Senior level

Employment type

• Employment type

  Full-time

Job function

• Job function

  Health Care Provider

• Industries

  Business Consulting and Services, Hospitals and Health Care, and Consumer Services

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