Clarksburg, West Virginia
Eugene, Oregon
Orange, California
Marion, Illinois
Durham, North Carolina
Greenville, North Carolina
Posted: 03-Jan-23
Location: Frisco, Texas
Salary: Open
Categories:
Internal Number: 2305004784
As a part of the Tenet and Catholic Health Initiatives family, Conifer Health brings 30 years of healthcare industry expertise to clients in more than 135 local regions nationwide. We help our clients strengthen their financial and clinical performance, serve their communities, and succeed at the business of healthcare. Conifer Health helps organizations transition from volume to value-based care, enhance the consumer and patient healthcare experience and improve quality, cost, and access to healthcare. Are you ready to be part of our solutions? Welcome to the company that gives you the resources and incentives to redefine healthcare services, with a competitive benefits package and leadership to take your career to the next step!
JOB SUMMARY
The Manager of Population Health is responsible for overseeing a team of Personal Health Nurses and/or Utilization Review Nurses, as well as assigned employer groups/clients. Is able to collaborate effectively with internal partners and leadership to provide operational excellence. Has an extensive understanding of the tools and applications in the Conifer Core Outcomes Optimization (CCOO) to effectively review and improve account and team performance. Maintains a strong leadership role to include business insight while offering clinical expertise focusing on the improvement of health and cost containment for Conifer clients. The Manager of Population Health directly interfaces with the client to present medical management outcomes and statistics and builds individualized medical management reports. Oversees the performance of their team and works closely with the nurses to ensure that all expectations and goals are met. Responsible for Human Resource activities, including staffing, performance reviews and input into compensation evaluations.
ESSENTIAL DUTIES AND RESPONSIBILITIES
Include the following. Others may be assigned.
- Daily Management of Team: Motivates the team to function cohesively by; communicating and implementing change, addressing and resolving concerns, escalates appropriately to leadership, plans and participates in staff meetings and trainings, acts as a resource to the nurses, manages PTO and coverage of team members.
- Ongoing Management of Team: Completes and delivers performance evaluations, reviews the quality reports, reviews and addresses the team members �performance� scores, identifies training needs, external educational opportunities, provides positive feedback formally and informally, conducting and delivering new employee and annual evaluations utilizing CCOO System Reports and Quality Reviews, completing Quality Training Reviews, Adheres to Conifer Corrective Discipline process, annual reviews of education requirements and conduct.
- Consults with Medical Director on issues of concern about member treatment plans, reviews and addresses outcomes accessible through the Outcomes report. Ensures that all �High Risk Strat� members are screened and opened for ongoing Medical Management if appropriate.
- Uses CCOO to document analytic time, uses CCOO reports as tools to provide ongoing training and orientation, Manages caseloads through CCOO case load management tool, Uses CCOO reports as tools for team management and account management.
- Account Management: Manages/assists team member�s management of accounts by providing leadership in the implementation of new customer. Participates in account meetings. Educates the nurse on the contractual requirements specific to the accounts they serve
- Works collaboratively with internal stakeholders and leadership. Performs on call duties weekends and Holidays on a rotational basis.
FINANCIAL RESPONSIBILITY
Responsible for reviewing, tracking and maintaining revenue budgeted projections and ensure they are in line with current staffing and plan performance. Tracking of expenditures as required to ensure adequate use of any and all resources in an efficient manner.
SUPERVISORY RESPONSIBILITIES
If direct report positions are listed below, the following responsibilities will be performed in accordance with guidelines, policies and procedures and applicable laws. Supervisory responsibilities include interviewing, hiring, and training employees; planning, assigning and directing work; appraising performance; rewarding and disciplining employees; addressing complaints and resolving problems.
- Direct Reports (titles) - 15-20 Personal Health Nurses and/or Utilization Review Nurses
- Indirect Reports (titles) - Occasional direction given to administrative staff
Conifer requires its candidates, as applicable and as permitted by law, to obtain and provide confirmation of all required vaccinations and screenings prior to the start of employment. This may include, but is not limited to, the COVID-19 vaccination, influenza vaccination, and/or any future required vaccines and screenings.
KNOWLEDGE, SKILLS, ABILITIES
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
- Competency in Microsoft Word, Excel, Power Point, Outlook as well as using email and attachments
- Excellent verbal communication skills with the ability to communicate with members and communicate professionally with individuals who serve in a variety of functions, i.e. physicians, account managers, brokers, customer service staff, Conifer executive management, other case managers, hospital utilization review nurses, etc.
- Excellent written communication skills with the ability to write in a professional, business manner
- Ability to analyze and resolve complex problems
- Team management abilities: resolve team conflicts, lead a diverse group of individuals, effect change in others, motivate a group of individuals to function as a team
- Excellent organizational, prioritization, and time management skills
- Ability to make logical and objective decisions
- Ability and willingness to function independently
- Flexibility and willingness to change
- Understanding of the CMSA Standards of Practice
- Understanding of Conifer�s holistic approach to medical management
- Understanding of the client�s (customer�s) perspective and needs
- Understanding of legislative acts, such as the ADA, ERISA
- Understanding of CMSA Standards of Practice and Professional Code of Ethics
- General understanding of cost containment and how it relates to medical management
EDUCATION / EXPERIENCE
Include minimum education, technical training, and/or experience preferred to perform the job.
REQUIRED
- A Registered Nursing degree and licensure as a registered nurse in state of residence with eligibility for unrestricted licensure in all states, or
- Certification as a case manager and licensure as a registered nurse in state of residence with eligibility for unrestricted licensure in all states.
- Certification in Case Management is required of Team Leaders who have directly supervised the case management process for three or more years.
PREFERRED
- A Bachelor of Nursing degree
- Five (5) years of UM/CM experience
- Certified Case Manager (CCM)
- Registered Nurse licensure in all states where contracts are held
- Three to five (3-5) years of diverse clinical experience
- Two to three (2-3) years of managerial experience
REQUIRED CERTIFICATIONS/LICENSURE
- RN (Registered Nurse) license required
- Current active professional license in the state of residence
- Eligibility for unrestricted professional licenses in all states
PHYSICAL DEMANDS
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
- Must be able to work in sitting position, use computer and answer telephone
- Ability to travel
WORK ENVIRONMENT
The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
- Remote Work Environment
TRAVEL
- Approximately 25% - 30% travel may be required
OTHER
- Ability to adhere to attendance policy as position requires consistent attendance
Employment practices will not be influenced or affected by an applicant�s or employee�s race, color, religion, sex (including pregnancy), national origin, age, disability, genetic information, sexual orientation, gender identity or expression, veteran status or any other legally protected status. Tenet will make reasonable accommodations for qualified individuals with disabilities unless doing so would result in an undue hardship.