As a part of the Tenet and Catholic Health Initiatives family, Conifer Health Solutions is a leading healthcare business process management services provider working to improve operational performance for more than 600 clients so they can support financial improvement, enhance the patient experience, and drive value-based performance. Through our revenue cycle management, patient communications, and value-based care solutions, we empower healthcare decision makers—hospitals, health systems, physicians, self-insured employers, and payers—to better connect every point of care and wellness management. Are you ready to be part of our solutions? Welcome to the company that gives you the resources and incentives to redefine healthcare services, with a competitive benefits package and leadership to take your career to the next step!
Conifer Health Solutions is hiring for a Manager, Nurse Case Management.
Reporting to Tenet leader for ACO Clinical Operations, this position will contribute to the ACO success related to improved health outcomes, increased patient engagement in self-care, and improve coordination and health care delivery through our ACOs at Tenet Healthcare.
Provide day-to-day operational oversight of ACO clinicians assigned to the market including –
• Assess, optimize and maintain daily case load
• Prioritize daily operational activities and workflows of ACO Clinicians that are aligned with overall ACO objectives
• Conduct ongoing ACO clinicians performance audits, coaching and review of performance reports
• Establish performance metrics and targets for the ACO clinicians
• Conduct annual performance review and offering input to Tenet ACO Leader for Clinical operations on ongoing staff performance
• Escalate any issues to Tenet ACO Leader for Clinical operations
• Participate in planning and implementing a streamlined process for annual data collection requirements by health plans
ACO Clinical Programs
• In conjunction with Tenet ACO leader of clinical operations, develop and implement clinical programs and initiatives that are aligned with overall ACO objectives
• Identify and develop performance metrics
• Assist with development and revision of care management interventions, protocols and policies
Staff Training & Orientation
• In collaboration with Lead ACO Clinical Care Coordinator, conducts new hire training and orientation
• Drives a culture of team work, collaboration and problem solving
Facilitates continuity of care for patients within high risk and potentially at-risk ACO populations
• Daily review of care management data to identify and initiate outreach
• Coordinate with patient and physicians for specific patient care needs and communication
• Complete transition of care activities for patients on the ACO care management inpatient census
• Identify patients at risk, assess to determine the level of risk (low, moderate, high) and provide recommended action and engagement to ACO patients and physicians
• Coordinate with Tenet hospital case management teams as needed for ACO member care or transition needs
• Conducts case/disease management for patients as required and makes referrals where necessary
The individual’s responsibilities include the following activities: a) Provide telephonic outreach for assessment, and follow up to close gaps in care, b) care coordination, c) transition planning assessment and reassessment, d) implementation of the transition plan, e) facilitating multi-disciplinary cross continuum patient care needs, f ) identifying and referring complex patients to disease management programs and community resources as needed, g) communicating with patients and families about the plan of care, h) collaborating with physicians, office staff and hospital departments, i) complete patient education to support health needs , j) provide timely, complete and concise documentation k) identification and documentation of potentially avoidable days, l) identification and reporting over and underutilization, m) and other duties as assigned.
KNOWLEDGE, SKILLS, ABILITIES
• Experience in Case Management or other managed care environment
• Knowledge of disease specific states, clinical and community resources.
• Strong critical thinking and problem solving skills.
• Ability to network, advocate, communicate assertively with all stakeholders
• Ability to work with high volume and strict timeframes
• Excellent communication skills
• Exceptional organizational skills especially while multitasking
• Ability to work in fast paced environment
• Works well independently as well as part of a team
• Strong commitment to help others
EDUCATION / EXPERIENCE
• Minimum Education: RN or LVN or LPN with active licensure status in the applicable state/s
• Preferred Education: BA or BS in Nursing
• Minimum Experience:
o 2+ years disease management, case management or formal patient education experience
o 2+ years of experience leading clinicians and teams
• Preferred Experience:
o 3 to 5 years disease management, case management or formal patient education experience
o CCM Certification
Conifer Value Based Care