Apply For Future Opportunities - Clinical Care Manager (Puerto Rico)

Healthmap Solutions Puerto Rico

10d•$56,087 - $83,481•Hybrid

About The Position

The Clinical Care Manager develops and maintains long-term relationships with physicians, physician office staff, and Healthmap members participating in Healthmap’s Kidney Management Program. The role coordinates performance-improvement activities and care management to improve health outcomes. The position involves regular travel within the assigned region to support practices and other healthcare or clinical sites as needed, and requires residency on the island of Puerto Rico.

Requirements

Associate degree, nursing diploma, or bachelor's degree in nursing.
Active, unrestricted RN license.
At least 3 years of progressive experience in healthcare services, clinical operations, quality, or care management.
Valid, unrestricted driver's license and automobile insurance as required by law.
Bilingual fluency in English and Spanish.
Residency on the island of Puerto Rico.
Ability to successfully comply with the credentialing process.
Excellent verbal, written, and presentation skills.
Interpersonal skills to develop and maintain strong internal and external relationships.
Ability to multitask, prioritize, and create solutions in a fast-paced environment.
Demonstrated leadership skills and ability to create and maintain a positive work environment.
Strong critical-thinking and analytical skills.
Ability to foster strong employee engagement among the team.
Proficiency in Microsoft Office, including Outlook, Word, Excel, and PowerPoint.
Ability to travel regularly within the assigned region to support practices and, as needed, other healthcare or clinical sites.

Nice To Haves

Three years of experience in care-gap closure or care-coordination activities, including in an outpatient or hospital setting.
Prior experience building and managing relationships with, and influencing, healthcare providers or patients.

Responsibilities

Act as a liaison between Healthmap, provider practices, and Healthmap members to support positive program engagement and performance.
Develop provider and partner business relationships that improve provider and member engagement, and manage an assigned caseload.
Identify opportunities to improve member health outcomes using provider-specific data.
Educate providers and support best-practice sharing, process improvement in provider workflows, Kidney Health Management interventions, and HEDIS/STAR measures in areas of low provider performance.
Educate provider offices about Chronic Kidney Disease, End Stage Renal Disease, Renal Replacement Therapies, and related topics.
Partner with physicians and physician staff to identify members who may benefit from Care Navigation, conduct outreach, and engage members in the program.
Educate members about kidney health, related comorbid conditions, and renal replacement therapy.
Advocate for members, use community resources and programs, and coordinate among members, their support networks, treating physicians, and ancillary providers to help members meet individualized goals.
Meet individual and departmental metrics and key performance indicators established by the organization.
Ensure timely and successful delivery of reports to internal and external stakeholders.
Maintain thorough documentation of provider and member interactions for coordination, consistency, and compliance with NCQA standards.
Follow Healthmap policies and procedures and comply with HIPAA privacy laws and other federal, state, and local regulations.
Perform other related duties as assigned.