Mgr Care Management - PAS

GENERAL SUMMARY:





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Under the direction of the Regional Director, Post Acute Services, the Manager, Post Acute Service, is responsible for region activities related to skilled nursing facility management of Health Net members for all lines of business.? A strong focus is placed on regional level development, implementation and monitoring of utilization and outcomes assuring compliance with state regulations and NCQA standards and outcomes in accordance with corporate policy and procedures.





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DUTIES and TASKS:





60%





1.?????Working with Regional Directors and appropriate Senior Medical Director, implements post acute services programs geared towards specific state situs based populations. Manages the day-to-day operations to support post acute services. Personnel management of staff.? Works with vendors, providers and Health Net Care Managers in program implementation and monitoring of health outcomes.? Oversees team of nurses and support staff responsible for inpatient Management, either telephonically and/or on-site as necessary.? Is familiar with application of InterQual Criteria and assures that associates consistently apply criteria. Assures the care given to our members is appropriate and compliant with Health Net policy, governmental regulatory requirements and accreditation initiatives.





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20%





2.?????Participates in the planning, implementation and assessment of regional and corporate programs designed to proactively identify members who are at risk and in need of care management services.? Implements processes to assure that members are enrolled in the appropriate program.?? Use utilization data as well as outcome data to measure a program's effectiveness.? In collaboration with Disease Management and Care Management, monitors the effectiveness of state implemented care management programs on health outcomes. Assesses and revises state level Care Management programs to optimize health outcomes.





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10%





3.?????Works in collaboration with the Regional Director to identify areas of opportunity and/or member, provider education.? Communicates with providers, members and community resources, as necessary, to support the planning, implementation and evaluation of Post Acute Care management programs.





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5%





4.?????Participates in corporate and state regulatory activities. Performs audit activities, as required, participates in establishment of corrective action as necessary.





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5%





5.?????Other duties as assigned.





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SKILLS/REQUIREMENTS:





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1.??????? Current RN professional licensure is required, Baccalaureate degree preferred. Experience in Skilled Nursing Facility and home health delivery systems and operations required.





2.??????? Five years of clinical experience, at least two years of supervisory experience, preferably with HMO experience in a medical management capacity is preferred.





3.??????? Extensive experience with nationally developed clinical criteria.





4.??????? Project management experience highly desirable. Needs specific understanding of medical management tools.





5.??????? Demonstrated progressive patient management expertise is required.





6.??????? Must have a "can-do" attitude and a proven successful track record in the assessment, planning, implementation, coordination, monitoring and evaluation of the management of member's care.





7.??????? Proficiency with Windows based applications is required.





8.??????? Must be goal-oriented and able to participate in a team environment with other motivated associates to move towards a common goal.





9.??????? Must have the ability to work in an environment of continuous process improvement.





10.?????? Local and overnight travel is required.





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