Population Health Management Supervisor RN

Community First Health Plans • San Antonio, TX

63d

About The Position

Provides supervision to the team which includes case managers, service coordinators, pharmacy technicians, health educators and administrative staff to facilitate compliance with quality and regulatory requirements. Works with all staff within the team to monitor and prioritize work loads, as well as formulate and communicate plans that efficiently utilize health care services in the safest, most cost-effective manner. Monitors and analyzes routine, ad hoc reports, case load, and care coordination management efforts for the team. Assists Community First Health Plan (CFHP) members regain optimum health or improved functional capacity by managing teams which ensure that members have access to all the health care services they need in the most efficient and effective manner possible. Responsibilities include, but are not limited to: overseeing the allocation of resources, cost and quality of health care for members; ensuring the team coordinates care between the primary care physician, community resources, family and member; coordinates care across the health care continuum to include preventive health and social determinants of health efforts while monitoring and managing benefit utilization; and, collaborates with multidisciplinary health care team members in identifying the educational and transition of care needs of members.

Requirements

• Five years of applicable experience required with a Licensed Vocational Nurse (LVN); OR six years of applicable experience with an Associates of Science in Nursing (ASN); OR five years of applicable experience required with a Bachelor's of Science in Nursing (BSN)
• Applicable experience for this position is defined as, but not limited to, experience in acute care, quality management, managed care, medical operations or business operations/settings.
• Knowledge of InterQual screening criteria, coding resources (DRG, ICD and CPT), and Medical Information/Medical Management Systems is required.
• Knowledge of Medicaid, community resources, alternate funding programs, Texas Health and Human Services Commission and Texas Department of Insurance HMO standards and NCQA in a managed care setting is required.
• Clinicians serving as a supervisor must hold/maintain current licensure requirements in his/her specialty with the State of Texas.
• All staff serving as a supervisor must maintain a current certification from an appropriate professional agency (such as Case Management Society, Six Sigma, Project Management, etc.) or must be obtained within 24 months of accepting the position.

Nice To Haves

• Supervisory experience is preferred.

Responsibilities

• Provides supervision to the team
• Monitors and prioritizes work loads
• Formulates and communicates plans that efficiently utilize health care services
• Monitors and analyzes routine, ad hoc reports, case load, and care coordination management efforts for the team
• Overseeing the allocation of resources, cost and quality of health care for members
• Ensuring the team coordinates care between the primary care physician, community resources, family and member
• Coordinates care across the health care continuum to include preventive health and social determinants of health efforts while monitoring and managing benefit utilization
• Collaborates with multidisciplinary health care team members in identifying the educational and transition of care needs of members.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: Associate degree
• Number of Employees: 251-500 employees