Clinical Case Manager, RN

Millennium Physician Group•Melbourne, FL

3d•Hybrid

About The Position

The ACO Clinical Manager is primarily responsible for the day to day operations of an integrated multi-disciplinary clinical and clinical support structure that will effectively monitor, support, and lead ACO clinical initiatives. This includes but is not limited to case management, discharge planning, care coordination and continuity, provider/staff education on ACO/MA Plan clinical programs, and helping to build and maintain a network of community support. This individual must exhibit strong leadership, management, and interpersonal skills, as well as the ability to utilize both internal and external resources to accomplish the goals and objectives of the organization.

Requirements

Bachelor's degree from four-year college or university; or one to two years related experience and/or training; or equivalent combination of education and experience.
Ability to read, analyze, and interpret the most complex documents.
Ability to respond effectively to the most sensitive inquiries or complaints.
Ability to apply basic mathematical concepts.
Ability to define problems, collect data, establish facts, and draw valid conclusions.
Ability to interpret an extensive variety of technical instructions in mathematical or diagram form and deal with several abstract and concrete variables.
Knowledge of Electronic Medical Records (Athena Database software); Microsoft Spreadsheet software and Microsoft Word Processing software; including Excel.
Registered Nurse

Responsibilities

Effectively manage day to day ACO/MA Plan Clinical Programs to enhance clinical efficiencies
Identify opportunities for increased outpatient vs. inpatient utilization
Utilizes data provided to help in managing population health needs and implements population programs for ACO/MA Plan beneficiaries
Execute case management for patients identified at highest risk for adverse event or exacerbation having ability to impact, with goal of decreasing unnecessary emergency department visits/hospitalizations
Oversee extended patient care team including but not limited to: Social Workers, Emergency Department Liaisons, Behavioral Health Liaisons, and Home Health Liaisons.
Oversee smooth Transitional Care Management for all patients discharged from in patient facility (hospital, skilled nursing/rehab, behavioral health) ensuring: Primary Care Provider visit, DME and Home Health Services, Specialist appointments, and community resources/social services are provided as indicated.
Ensure Quality Measures are reviewed and addressed when applicable/appropriate
Implement and direct ACO/MA Plan Health Education Activities for beneficiaries, providers, and staff
Participate in Care Coordination and Quality Committees, Primary Care Provider POD Meetings, Hospitalist POD Meetings, Hospital Joint Operation Meetings, JOC Meetings, and other meetings as required
Monitor corporate initiatives and strategies to achieve utilization of business and financial goals
Manage the successful integration of ACO Programs into current operations to meet the goals of all stakeholders
Maintain collaborative relationships with business partners both within the company and the community
Manage and execute organizational opportunities and implement changes that are in alignment with corporate financial goals and strategic endeavors.