About the position
The Program Manager of Care Management is a core member of the Care Management (CM) program development and operations team and serves as a cross-functional team communicator and collaborator. This role shapes the CM program using the voice of our members and our internal care management team to support, design, and improve our CM programs. This position plays a critical role in standardizing CM processes across all markets, promoting scalability and efficiencies to support quick company growth. This role works closely with executive and market leadership to develop medical and functional health programs that support AbsoluteCare's mission of delivering integrated care and reducing unnecessary utilization for a vulnerable and chronically complex population. This includes designing, implementing, and measuring outcomes of CM programs across all markets and product lines following health plan, regulatory, and NCQA standards. This position serves as a subject matter expert (SME) for medical CM programs including Chronic Condition and Disease Management, functional health and integration with our Collaborative Care model for behavioral health. This role serves as the CM liaison for training content development, market leadership support, and communications/marketing. The CM Program Manager creates and maintains internal and external facing relationships with key stakeholders. This role reviews and analyzes data to identify key stakeholders, process improvements, and program opportunities to support program success. Key performance indicators (KPIs) include reducing potentially preventable events (e.g., ER visits, hospital admissions (medical/psychiatric, and readmissions), increasing medication adherence, overcoming social determinants of health (SDoH), increasing member engagement with community resources, and member retention. Functions include drafting and maintaining CM policies and procedures, job aids, training content, and program descriptions.
Responsibilities
- Collaborate with product, operations, marketing, and care management teams to influence and shape the CM program design and strategy, drive change for key issues
- Prioritize programmatic changes based on issue volume, members impacted, utilization/revenue impact, and other relevant metrics
- Act as the primary CM point of contact for various AbsoluteCare teams as the CM SME, participating in model of care design, collecting feedback from other departments, and communicating it back to the leadership team in an actionable way
- Aggregate and analyze team and member feedback using internal tools, surveys, and available data to gather insights and propose actionable process improvements or program development
- Work with learning development/training team to drive creation of CM content to ensure the CM team is provided key job training and answers to frequently asked questions
- Draft and maintain CM policies and procedures, job aides, training content, and program descriptions
- Meet deadlines and manage competing priorities
Requirements
- Bachelor's level required with advanced degree in nursing, health services or business preferred, e.g., MSN, MPH, MHA, MBA
- RN licensure preferred (e.g., RN, APN, CNS)
- 5+ years of experience in care management, medical and/or functional health process improvement and program development
- 3+ years of experience in a community health center, managed care organization, FQHC, inpatient facility or other setting that serves clientele with complex Behavioral, Medical/Functional and SDoH needs
- Experience with complex government-sponsored populations preferred, e.g., Medicaid, Medicare beneficiaries
- Experience with member engagement, transitions of care, clinical care, and/or case management
- Advanced computer skills with proficiency in Outlook, Word, Power Point, Excel
- Experience working in multiple electronic health records
- Excellent oral and written communication skills with ability to format and present to internal and external stakeholders
- Advanced ability to influence in a matrixed environment
- Excellent organizational and time management skills to prioritize and meet deadlines
- Ability to analyze data to identify and implement process improvements
- Proven record of ability to lead through change in a dynamic environment
- Active CPR certification
