North Texas - Manager, Health Services

We are a fast-growing health care company with Medicare Advantage health plans in multiple states.  We have plans to grow through acquisitions and new startup operations in additional markets over the next few years.  This growth and added complexity of our operation is requiring a significant investment in human resources as well and as a result we have a new opening for a Manager of Health Services.

 

PURPOSE OF JOB:

Develops, organizes, directs and maintains all Health Services functions for North Texas Operations.

 

JOB COMPONENTS:

1.  Develops and supports implementation of overall strategic plan and departmental budget in order to achieve health plan financial and organizational goals.

2.  Achieves stated health services targets for quality, utilization and staffing.

3.  Develops and establishes necessary operational infrastructure to support the UM/QI disease management and other clinical coordination programs within established benchmarks and model requirements.

4.  Oversees plan?s compliance and quality and disease management efforts to support the plan?s accreditation and regulatory objectives.

5.  Communicates, collaborates and assures cooperation with network and community physicians, hospital leaders, providers and other vendors regarding care coordination, disease management, and access to quality, cost effective health care services.

6.  Educates plan staff, members, families, providers and local community regarding healthcare quality/disease management, access to care, alternatives and available benefits.  Serves as an advocate for the plan?s objectives to improve health and well being of plan membership.

7.  Interacts with Contracting and Provider Relations to ensure coordinated approach and support for each department?s initiatives and communicates consistent messages in all interactions.  Promotes plan?s overall organizational and financial goals as well as improvement in overall quality of the member?s health care as the primary goal focus of any initiative.

8.  Monitors utilization frequency, quality/disease management and financial reports to identify changes in access patterns, trends or overall quality in the health care of the plan membership.

9.  Adopts and shares best practices with clinical leaders with the delegated networks.

10. Identifies, trains, and evaluates the UM/QI/Disease Management Staff.  Provides daily coaching as needed to improve performance and achieve stated goals.

11. Ensures that weekly audits are conducted of case documentation (including tracking logs) to ensure that process standards and inter-rater reliability standards are met, and successful outcomes are achieved.

12. Ensures the census report is reviewed daily with the delegated network to ensure review efforts are focused and prioritized.

13. Facilitates Medical Director in care coordination interaction and problem solving.

14. Ensures regular team meetings are conducted for communication and feedback, staff training and development, sharing of program results, and collaborative problem solving.

15. Is available and accessible to the delegated network for care coordination and serves as a resource to support care coordination in conducting clinical reviews and implementing appropriate follow-up interventions.

16. Provides direction, advice and assistance in areas of policy and procedure, and efficiency of Utilization Management and Disease Management to the delegated network Health Services Managers and Medical Directors

 

 

 

QUALIFICATIONS:

1.  RN, currently licensed by the State of Texas

2.  3+ years clinical experience in a hospital setting

3.  5+ years previous supervisory experience that includes Quality Assurance and Utilization Management  and Disease Management experience.

4.  Minimum 5 years of experience in a managed care setting with in-depth knowledge of the industry.

5.  Strong team building skills

6.  Change agent:  strong mentoring and coaching skills

7.  Excellent management skills

8.  Data analysis and interpretation skills including utilization, financial, and operations data

9.  Budget and financial planning skills

10. Strategic planning skills

11. Creative problem solving skills

12. Professional in appearance and demeanor

13. Good problem solving techniques

 

 

Please apply online at https://www.adpselect.com/apps/jobfit.jsp?cst=1295042.  You can cut and paste this link into your browser. 

No phone calls, email or faxes accepted.  Only individuals who apply online at  https://www.adpselect.com/apps/jobfit.jsp?cst=1295042 will be considered candidates.