Value Based Care Manager/Long Term Care

Eventus WholeHealth; Indianapolis (IN); On-site; USD 60,000 - 100,000; Full time

Job summary

An established industry player is seeking a dedicated Value Based Care Manager to lead clinical operations in a dynamic healthcare environment. This pivotal role involves overseeing care coordination, ensuring compliance with regulatory standards, and fostering strong relationships with healthcare teams. The ideal candidate will possess extensive experience in clinical management and a passion for delivering exceptional patient care. Join a forward-thinking organization where your contributions will directly impact the quality of healthcare services provided to the community. If you thrive in a fast-paced setting and are committed to excellence, this opportunity is perfect for you.

Qualifications

• 3+ years of clinical care and management experience required.
• Strong knowledge of CMS regulations and ISNP programs.
• Must hold a current RN license for the state of practice.

Responsibilities

• Provide clinical leadership to ensure quality care delivery.
• Track clinical metrics and implement improvement strategies.
• Collaborate with healthcare teams to enhance operations.

Skills

Clinical Care Management

Skilled Nursing Facility Experience

Quality Management

Communication Skills

Interpersonal Skills

Organizational Skills

Customer Service

Education

Current RN License

Certification as Nurse Practitioner

Tools

Microsoft Office

LTC Clinical EMRs

Virtual Meeting Platforms

Job description

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Position Summary

The Clinical Leadership team member provides clinical leadership and oversight for the health plan providers. The COM coordinates care between the partnering SNFs' clinical leadership, the SNF interdisciplinary care team, and the health plan team to ensure the delivery of excellent, health care as prescribed by the adopted Model of Care (MOC). The COM oversees the day-to-day clinical operations, supporting quality health care delivery, clinical proficiencies, utilization management, and business development while adhering to the Model of Care and other regulatory/accreditation guidelines. Additionally, the Clinical Operations Leader is responsible for managing and developing the clinical team, which includes Nurse Practitioners (NPs), and Registered Nurse Care Coordinators (RNCCs). This role requires time in the field, collaborating and coordinating care with the clinical leadership and interdisciplinary care teams at partnered and potential skilled nursing facilities.

Essential Duties And Responsibilities

1. Provide clinical and strategic leadership to ensure excellent and efficient quality of care in accordance with the adopted clinical model of care.
2. Track progress, identify barriers, and implement strategies to meet established clinical utilization and quality metrics.
3. Maintain knowledge and achieve compliance with federal, state, and local regulatory requirements, licensure, and accreditation requirements.
4. Design, develop, and implement strategic initiatives, educational programs, policies, and procedures for efficient clinical operations and achievement of financial and quality metrics.
5. Assist in maintaining financial objectives and cost improvement programs.
6. Collaborate with ISNP and delegated senior leadership to drive performance and establish innovation within the company.
7. Interact with attending physicians and skilled nursing facility medical directors to establish successful working relationships for the health plan.
8. Support functions such as auditing, documentation management, HEDIS/Stars quality measures, and policies & procedures.
9. Manage and report utilization results against targets for acute and SNF admissions, Part A and B skilled services.
10. Assist with clinical assignments as needed.
11. Support human resource management of the clinicians, including functions such as hiring, terminations, and performance evaluations.

Required Experience

• Minimum of 3 years of clinical care and management experience.
• Skilled Nursing Facility/Long Term Care experience.
• Knowledge of CMS regulations and core aspects of an ISNP program.
• Experience in the development of clinical operations, quality management, and performance management.
• Proficient in basic computer skills, virtual meeting platforms, Microsoft, and LTC clinical EMRs.
• Clear, concise, and persuasive verbal and written communication.
• Adept at interacting with members and their families, other clinicians, senior leadership, and all levels of medical and non-medical professionals.
• Solid teaching skills.
• Good interpersonal and organizational skills with attention to detail.
• Strong commitment to excellent customer service.
• Positive and enthusiastic attitude.
• Must be highly motivated, organized, flexible, and adaptable to working in a fast-paced, dynamic environment.
• Must hold oneself to a high level of autonomy and accountability.

Required Licensure, Certification, Credentialing & Other

• Current unrestricted RN license for the state of practice
• Current certification as an Adult, Geriatric, or Family Nurse Practitioner in the state of practice preferred.
• Holds or is eligible for DEA licensure and CDS licensure (if required in the state of practice) if an advanced practice nurse.
• Holds a valid driver’s license and car insurance and has reliable transportation

PHYSICAL REQUIREMENTS

The physical demands described here are representative of those that must be met by an employee to successfully perform the job.

• Regularly communicate with others, often in high-pressure environments.
• Frequently move about the office, access files, use office equipment, and interact with others.
• Sit or remain stationary for extended periods to work, communicate, and use the computer.
• Occasionally stand or access files and equipment in high places.
• Operate computers, phones, and other office equipment constantly.
• Bend, stoop, kneel, crouch, or crawl occasionally.

WORK ENVIRONMENT

The work environment is usually low to moderate noise. The role requires effective interaction with others, managing conflict, and handling stressful situations. Office work and flexible hours are typical.

Additional Details

• Seniority level: Mid-Senior level
• Employment type: Full-time
• Job function: Health Care Provider
• Industries: Hospitals and Health Care