Senior Manager of Clinical Operations
Company: Elderwood Health Plan
Location: Grand Island
Posted on: June 25, 2022
Job Description:
Join Our Team: Put the CARE back in CAREER - Join our team
today! Overview:Join a company that cares for YOU!
Our Excellent, Competitive Compensation, and a Full Benefit Package
includes:
- Up and Coming downtown location with FREE PARKING!
- Competitive wages and opportunities for advancement
- Medical, Dental, Vision Insurance
- Life insurance
- 401(k) with matching
- Paid Holidays
- Generous Paid Time OffSummary:
The Senior Manager Clinical Operations interfaces directly with the
Care Services Manager (Social Work/Member Services) and RN Care
Managers to ensure timely assessment and coordination of
appropriate levels of care for delivery of patient centric
comprehensive services to Elderwood Health Plan members within the
MLTC benefit structure through leadership and oversight to the
Utilization Management team and external provider collaboration.
The Senior Manager of Clinical Operations also works closely with
the Director and Medical Director specific to forward strategic
clinical planning applicable to sustainable expansion and growth of
the health plan. This individual is a core member of the QAPI work
group to conduct research and development activities applicable to
both service area and product expansion efforts.Employee Perks!:
401K Retirement Plan with Company Match, Clean, Neat & Newly
Renovated Facility, Close to thruway entrances/exits, Consistent
work and holiday rotations to provide you with a great work/life
balance, Employee of the Month recognition, Enjoy a fun and diverse
work environment, Enjoy being a part of a strong and diverse team,
Free On-Site Parking, Generous PTO & holiday package, Life
Insurance, Medical, Dental, and Vision insurance, Point-earning
employee reward program: redeem for prizes!, Strong leadership,
Truly make a difference in our residents' lives while providing top
notch care Responsibilities:
- Provides direct oversight of the Utilization Management Team,
managing all daily processes in totality impacting Risk and NFLOC
scores in accordance with regulatory requirements and internal
Elderwood
- Ensures timely escalation and visibility specific to need for
appropriately licensed and knowledgeable staffing and/or resources
necessary to effectively conduct care management nursing functions
across plan population for finance
- Responsible for full cycle talent acquisition process and
decision-making of Utilization Management staff to include, but not
limited to job posts, interviewing,
- Responsible for staff performance evaluations, administering
discipline, training and/or
- Responsible for scheduling, approving timecards and processing
payroll for direct
- Ensures appropriate training and education is provided for UM
onboarding, new process, and remedial
- Ensures all UM focused care management activities are performed
in accordance with contractual requirements, state policy, and
plan
- Ensures plan emergency management policy and procedure remains
intact with appropriate staff training and oversight/external
provider collaboration for high risk
- Monitors the effectiveness of existing procedures and
outreach/intervention efforts in demonstrating positive outcomes
for members and high satisfaction for participating
- Ensures appropriate case planning, education and interventions
are conducted for members in accordance to risk level and acuity
of
- Ensures exchange of information between plan and behavioral
health/medical/ancillary providers in recommending and obtaining
effective interventions for comprehensive care plans for at-risk
members.
- Reviews and evaluates all requests for internal plan appeal,
and Fair Hearing if required, with determination and notification
requirements according to policy and regulatory guidelines.
- In response to performance data, addresses key care management
outcomes and implements UM improvement activities to maximize
ability for closure of service gaps and achieve timely resolution
for identified member needs.
- Ensures timely and effective coordination of care specific to
CHHA requests/referrals between internal team and external vendors;
provides regular updates.
- Actively participates in strategic planning and competitive
intelligence specific to enhancement of care management functional
processes and build of required infrastructure for benefit
administration/ utilization review, provider oversight and
collaboratives such as VBP and expansion efforts.
- Provides training to team and address any gaps in policies and
procedure that are identified.
- In participation with the QAPI Work Group, establishes
guidelines for safe and appropriate care planning as well as
benefit administration/utilization management practices that meet
all plan and regulatory requirements.
- Ensures efficient management of assignments, competency and
educational needs of the UM team and effectively coordinates and
controls resources.
- Monitors performance against defined operational metrics and
establishes mechanisms for reporting on nursing care management
indicators.
- Performs routine regulatory monitoring of nursing functions and
coordinates/participates in external quality and audit
activities.
- Actively collaborates with Care Services Manager in the
discharge planning process with direct nursing clinical
recommendations with the facility discharge planner to ensure
timely discharge, appropriate follow up and continuity of
care.
- Escalates cases with quality of care concerns to director to
arrange for team review and resolution. Protects member rights at
all times.
- Remains flexible and responsive to changes in schedule,
workload or focus and champions a culture of excellence.
- Travels to off-site meetings as directed, arrives to work on
time, regularly, and works as scheduled.
- Recognizes and follows the dress code of the facility including
wearing name tag at all times.
- Follows policy and procedure regarding all electronic devices,
computers, tablets, etc.
- Supports and abides by EHP's Mission, Vision, and Values.
- Abides by EHP's businesses code of conduct, compliance and
HIPAA policies.
- Performs other duties as assigned by supervisor, management
staff or Administrator.Base salary starting at (note: salary
increases with experience):: USD $82,000.00/Yr. Qualifications:
- Minimum of bachelor's degree in nursing (BSN); Master's in
Nursing or equivalent preferred
- Minimum of 8 years of clinical nursing experience with at risk
populations in home care, case management, utilization review,
discharge planning or managed care
- Recent experience as a lead in a functional area, managing
cross functional projects (i.e. Change Management, payment
reform/DSRIP/VBP), and supervisory experience including hiring,
training, assigning work and managing the performance of team
- Recent experience working as a supervisor performing case
and/or utilization management functions, with thorough knowledge in
assessment, diagnosis, treatment approach for individuals with
medical/behavioral conditions, case management methodology, mental
health community resources and local health delivery systems
- Demonstrated computer skills with Microsoft Office,electronic
medical records, web-based programs and external coordination sites
applicable to position (i.e. UAS-NY, RHIO)
- Current, valid driver license
- In good standing with and demonstrated knowledge of Medicare
and Medicaid programs
- Demonstrated proficiency in HIPAA Privacy and Security
compliance
- Bilingual Spanish speaking skills preferred
Keywords: Elderwood Health Plan, Buffalo , Senior Manager of Clinical Operations, Executive , Grand Island, New York
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