Program Manager, Care Management

US-CA-Irvine
Req No.
2017-2152
Category
Operations
Type
Regular Full-Time

Overview

ConcertoHealth Inc. is the leading provider of specialized primary care and supporting clinical services for complex, frail, elderly, and dual-eligible patients. Operating exclusively in value-based agreements, ConcertoHealth provides high-touch, individualized care for patients, and deploys wraparound clinical resources to extend the reach of primary care practices. This comprehensive medical management solution, elevated by Concerto’s proprietary population health technology, improves overall healthcare quality and patient outcomes, benefitting payers and their provider networks. The company is headquartered in Irvine, Ca. For more information, please visit www.concertohealth.com.

 

Job Summary:

The Program Manager, Care Management reports to the VP, Care Management and is a cross-functional position that will support and guide care management functions in a fast paced, growth oriented population health organization. This dynamic role will support and organize teams across the company for a complex patient population using innovative technology solutions in a multidisciplinary care setting. This role will be accountable to achieve exceptional service and meet contract commitments to health plan partners and regulators, and drive project implementation activities and best practice policies and processes. The role will support strategy development and execution for a range of care management professionals, including clinical and non-clinical positions, who collaborate to serve a diverse membership base.

Responsibilities

The Program Manager will be required to continuously assess the organization against known benchmarks and key competitors to ensure performance excellence from both clinical and operational standpoints.  This individual will also work hand in hand with the Vice President, Clinical Operations to assess, develop, and implement new technologies or processes that enable greater patient clinical outcomes or engagement.  This role will require a very self-driven, critically thinking individual with the ability to serve as a subject matter expert / advisor for senior levels of the organization.  Due to the start-up nature of this organization, a certain level of entrepreneurial spirit will be required to be successful.  Structured guidance will not always be provided.  Many elements of the business change at a fast clip, so this individual must be comfortable adjusting and flexing along with the business.

 

  • Collaborate with care management leaders to prioritize and execute critical initiatives and ensure resources are deployed sufficiently to ensure successful implementation
  • Manages detailed project plans for initiatives and new market implementations for care management
  • Develops and executes work plans to attain and maintain NCQA accreditation for care management and related functions
  • Monitor and develop key performance indicators for all clinical areas and escalate issues promptly
  • Reduce complex information into discrete action statements to drive business decision and alignment
  • Responsible for the development and execution of care management activities to drive compliance with health plan partners’ models of care
  • Develops and maintains collaborative relationships with other internal market leaders, payor partners, regulators and corporate teams
  • Leads cross-functional clinical and non-clinical meetings and other projects
  • Functions as market care management leader during implementation as needed to accommodate organic and new product growth
  • Monitors care management clinical operations as well as contractual and regulatory operational requirements during implementation and post-implementation to drive compliance, quality outcomes and operational efficiencies
  • Functions as care management subject matter expert, understands and maintains knowledge of delegated lines of business and community provider relationships
  • Monitors staffing and budget for care management
  • Supports and oversees care management acuity assignment methodology, including supporting new technology development by defining business specifications/requirements for clinical operations
  • Oversees risk stratification guidelines compliance through reviews of care management activities and systems reporting
  • Identifies and executes on best practices for care plan development and management
  • Responsible to support achievement of cost, quality, and patient/member experience goals
  • Directs, plans and evaluates care management documentation quality through the monitoring of the internal quality review tool(s)
  • Develops care management policies, procedures or other job aides as needed
  • Participates in collaborative meetings between various departments and care management across all markets, leads clinical operations oversight meetings and maintains agenda and written meeting minutes
  • Tracks and reports to market or corporate leadership using systems reports on a defined frequency, taking efforts to validate accuracy and completeness on a regular basis
  • Promotes a positive work environment, sets an atmosphere of open communication and feedback
  • Performs, at a minimum, an annual assessment of operational performance across all key success metrics
  • Other duties as assigned

Qualifications

2 - 4 years Health Plan care management experience required. Experience with Medicare and Medicaid programs required. Experience with programs including Long Term Services & Supports strongly preferred. Experience with NCQA Accreditation for Care Management preferred. Healthcare provider experience preferred. Ability to travel up to 15%. Ability to work in a Windows based computing environment. Strong interpersonal and critical-thinking skills.

 

Education/Experience: Bachelor’s degree in a related field required, Advanced degree preferred.

 

Language Ability: Ability to read and interpret documents such as safety rules, operating and maintenance instructions, and procedure manuals.

 

Ability to write routine reports and correspondence. Ability to speak effectively before groups of customers or employees of organization.

 

Math Ability: Ability to add, subtract, multiply, and divide in all units of measure, using whole numbers, common fractions, and decimals. Ability to compute rate, ratio, and percent and to draw and interpret bar graphs.

 

Reasoning Ability: Ability to apply common sense understanding to carry out instructions furnished in written, oral or diagram form. Ability to deal with problems involving several concrete variables in standardized situations.

 

Computer Skills: Must be able to proficiently use Microsoft Office skills and clinical applications.

 

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