Program Manager (Utilization Management Nurse)

Job Locations US-CA-Aliso Viejo
Req No.
2018-2293
Category
Clinical/Medical
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.

 

Concerto delivers comprehensive care to Medicare, Medicaid, and complex-needs patients. The Concerto name reflects our unique approach to healthcare. It’s about how we work in concert with patients, providers, and health plans. Our approach focuses on bringing harmony across the spectrum of a patient’s care, health, and dignity.

The company is headquartered in Irvine, Ca. For more information, please visit: www.concertohealth.com

 

JOB SUMMARY

The Project Manager will serve in a critical capacity for the organization as he/she will be focused on operational excellence of Concerto’s health care programs. The Program Manager will be required to continuously assess the department operations against accrediting and regulatory requirements as well as client policies, procedures and expectation.

Responsibilities

  • Evaluate processes to identify opportunities for improvement in compliance with regulatory and accrediting requirements.
  • Coordinate ongoing meetings with staff and leadership to determine process improvement activities, coordinate workgroups to revise processes, pilot and finalize revised processes.
  • Assist in documenting processes to ensure consistent application among staff.
  • Coordinate activities with department leadership, staff, and with clinical training and auditing staff.
  • Assist in various projects and initiatives to prioritize and execute critical initiatives and ensure resources are deployed sufficiently to ensure successful implementation.
  • Take initiative and support all clinical areas with project activities.
  • Assist with tracking and implementing new business opportunities.
  • Monitor and develop key performance indicators and escalate issues promptly.
  • Assist in requesting and evaluating appropriate reports.
  • Reduce complex information into discrete action statements to drive business decision and alignment.
  • Collaborate with all business functions and support other initiatives that impact clinical areas.
  • Support VP Utilization Management with ad hoc requests and projects.

Qualifications

  • BS in business or health care related field. Master’s Degree preferred.
  • 1-3 years of demonstrated analytics/operations experience in a healthcare, clinical, or population health setting.
  • Project management skills required.
  • Process improvement skills required, with Six Sigma training preferred.
  • Strong analytical skills required, including a thorough understanding of how to interpret business needs and translate them into application and operational requirements.
  • Excellent verbal and written communication skills
  • Understanding of known benchmarks for staffing, execution, patient satisfaction, etc. of medical groups, care management, and utilization management.
  • Ability to direct and execute complex data analysis to support any recommendations.
  • Deep understanding of upstream and downstream impacts of any solution implemented and ability to plan and execute to mitigate risks.
  • Self-driven/directed.
  • Ability to interact professionally with a diverse group, executives, managers, front-line staff and subject matter experts
  • Strong ability to align objectives cross-functionally and drive change effectively
  • Expert level proficiency with Microsoft Excel, Access, PowerPoint and Word
  • Experience with Tableau preferred but not required

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