Supervisor, Care Management (53510)

GlobalHealth, Inc.; Oklahoma City (OK); À distance; USD 90 000 - 110 000; Plein temps

Résumé du poste

GlobalHealth, Inc. is seeking a Nurse Care Management Team Leader to guide SNP and high-risk member programs. The role reports to the Director, Health Services and focuses on staff development, program planning, and ensuring compliant care management processes.

You will lead a team of care managers, monitor performance, and collaborate with health services to optimize outcomes while protecting PHI under HIPAA policies.

Qualifications

• Active RN license in the state of Oklahoma.
• Active multi-state RN license preferred.
• Experience in managed care / utilization management preferred.

Responsabilités

• Develops and leads the Care Management Team.
• Promotes timely outreach and management of identified members.
• Analyzes outcomes to improve program effectiveness.
• Coordinates staff training and education.

Connaissances

Nursing knowledge

Leadership

Communication

Detail oriented

MS Office

Formation

RN license (OK)

Multistate license preferred

Outils

Microsoft Word

Excel

PowerPoint

Description du poste

Who We Are

GlobalHealth is a fast-growing Medicare Advantage HMO health insurer. We aspire to be the employer of choice in our industry, attracting and retaining a highly talented workforce. Our passion is

Who We Are

GlobalHealth is a fast-growing Medicare Advantage HMO health insurer. We aspire to be the employer of choice in our industry, attracting and retaining a highly talented workforce. Our passion is Genuine Care and Optimal Health for the members we serve. We are unique by providing high touch, high value and a partnership to our members. We go above and beyond to provide personalized, engaging, and responsive services to our members. We work hard to offer affordable health insurance coverage with the benefits people truly want and need. It is our hope to be more than just a health insurance company we want to be long-term partners with our members. We are looking for future employees who exude our core values of taking accountability through ownership, being driven, innovative and who have a passion for continuous learning.

Who You Are

This position, under the direction of the Director, Health Services, is responsible for the development and leadership of assigned members of the Care Management Team. This includes the determination, planning, development, organization, implementation and evaluation of SNP and other high risk, high utilization members.

Essential Job Functions

• Selects, orients, and develops appropriate qualified staff for the Care Management Department.
• Maintains and monitors departmental processes to promote the timely outreach and management of identified members.
• Evaluates established reports to identify outcomes and program effectiveness.
• Analyzes outcomes and uses data to develop new processes to improve program effectiveness.
• Identifies training needs and facilitates appropriate education and training.
• Communicates regularly with employees through participation in regular staff meetings to share information appropriate to their job functions.
• Serves as a resource to all lines of business.
• Communicates effectively with Director, Health Services regarding departmental issues, team member performance improvement opportunities, member issues, program status, and compliance issues.
• Must maintain confidentiality of business information, including Protected Health Information (PHI), as required by HIPAA and company policy.

Education And Experience

• Active Registered Nurse license in the state of Oklahoma required
• Active multi-state RN license is preferred
• Previous experience in managed care/utilization management preferred

Knowledge, Skills And Abilities

• Knowledge of current nursing processes, techniques, and established standards, including disease management, medications, and community resources.
• Strong attention to detail and good organization and time management skills, including ability to multi-task, learn new skills and reach set goals.
• Strong organizational, leadership, problem solving, and decision-making skills.
• Must be able to communicate, both orally and in writing, clearly and effectively
• Knowledge of Microsoft software programs including Word, Excel, and PowerPoint.
• Proven ability to work independently or as a member of a team.

Work Environment

Current work environment is remote, however, some state exclusions apply. Must have access to a reliable and secured internet connection source. Work environment must maintain confidentiality of business information, including Protected Health Information (PHI), as required by HIPAA and company policy. This position will also be required to use reasonable and necessary safeguards to protect GlobalHealth records from unauthorized access, disclosure or damage and will adhere to all GlobalHealth privacy and security policies.

Travel

Occasional travel may be required.

Supervisory Responsibility

Supervises members of the Care Management Team

Other Duties

This job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. Duties, responsibilities and activities may change at any time with or without notice.