Manager, Transitions of Care

Job Locations US-MI-Southfield
Req No.
2018-2298
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, benefiting 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.

 

Summary: 

Reporting to the Vice President, Utilization Management, this position manages the daily operations of the Transitions of Care (ToC) program for Concerto Health. This position ensures that all processes, programs and operations of ToC are fully implemented. The Transitions of Care Program is key to ensuring the safe and successful transition of members across the care continuum. The Manager, Transitions of Care facilitates interdisciplinary collaboration and ensures safe transition to appropriate care to mitigate the risk of inpatient readmissions and/or emergency department visits.

 

The position is responsible for collaborating with both the utilization management and care management teams in ensuring smooth transition for individuals transitioning between care settings.


In addition, this position is responsible for recruitment, hiring, training, development and retention of the Transitions Coach staff. 

 

Responsibilities

  • Implements ToC programs, policies and procedures to ensure that all functions meet internal, Health Plan, and Regulatory requirements.  Participates in the identification of members needing assistance with transitions of care and distribution of cases to the Transition Coaches. 
  • Participates in multi-disciplinary rounds with other members of the care team. 
  • Implements, monitors and ensures the ToC program meets regulatory and accrediting requirements as well as health plan Model of Care requirements.
  • Provides input in improving quality and utilization metrics focusing on inpatient readmissions and appropriate post discharge care.
  • Ensures staff competency utilizing record audit and participation in clinical rounds.
  • Ensures that members receive appropriate authorization and access to care post discharge.
  • Collaborates with other members of the leadership team to identify opportunities for process improvement that are consistent with the organization’s vision and strategic long-term goals.
  • Communicates with the staff both verbally and in writing to convey health plan, contract or operations information to ensure all staff members have a consistent and appropriate knowledge base to perform their duties. 
  • Promotes staff growth and development by identifying educational opportunities to increase efficiency and maintain compliance with industry standards.  Participates in the collection, analysis and reporting of data relevant to the ToC program. 
  • Responsible for recruitment and selection of staff. Responsible for orientation of new staff, on-going training, mentoring, and performance reviews. Conducts staff meetings, assuring policy and procedures are adhered to and when necessary, modified to address changing strategic objectives. 

Qualifications

  • A current Registered Nurse License in good standing
  • 5 years of nursing experience, preferably in home health care, hospital discharge planning, case management
  • Three (3) years management experience in a progressive leadership role
  • Experience with government programs, including health benefit programs serving vulnerable populations such as Dual Eligible beneficiaries (MMP or DSNP), Medicare Advantage and various Medicaid and State Waiver programs
  • Knowledge of Medicare regulations and programs related to transitions of care
  • Current working knowledge of discharge planning, utilization management, case management, performance improvement, and managed care
  • Strong interpersonal communication and negotiation skills
  • Strong clinical skills including an understanding of and ability to implement evidenced-based care
  • Strong organizational and time management skills

 

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