[Remote] Clinical Manager (North Area - Middlesex and Essex County)

Note: The job is a remote job and is open to candidates in USA. Point32Health is a leading not-for-profit health and well-being organization dedicated to delivering high-quality, affordable healthcare. The Manager, Integrated Care Management - Nursing is responsible for day-to-day operations and staff management, implementation of care management programs, and ensuring quality care and compliance with standards.

Responsibilities

• Responsible for implementation and monitoring effectiveness of new and existing Care Management programs, including but not limited to: Telephonic care management and onsite transition of care interventions
• Compliance with applicable regulatory and accrediting standards; care management process and interventions consistent with national best practices; demonstrated through scheduled department and quality audits
• Defining and monitoring outcomes and regular reporting for areas of accountability
• Interface with Care Management vendors and programs for bidirectional referrals
• Establishment of written policies and procedures pertaining to Care Management
• Provide direct oversight of coordinators, RN care managers and other interdisciplinary staff working in a remote and/or office-based or hybrid environment. May supervise staff performing member home visits
• Guide and enhance the core competencies and professional development of reporting staff
• Facilitate and enhance team collaboration to optimize program and member outcomes through integrated services
• Facilitate collaboration with internal and external stakeholders to maximize partnerships for case management program success, including alignment with provider network and employers
• Serve as consultant and resource for complex situations
• Oversee the management of department human resources related objectives
• Support realization of department administrative budget targets
• Represent Care Management in relevant corporate teams as required
• Implement and support fulfillment of corporate objectives within jurisdiction
• Other projects and duties as assigned

Skills

• Registered Nurse with current unrestricted Massachusetts license required
• Bachelor's degree or equivalent relevant experience
• 5 years of RN experience in nursing in a clinical setting
• Excellent communication skills (verbal, electronic, etc.)
• Must possess skills and traits of an effective Coach, Mentor, and Critical Thinker
• Demonstrates ability to manage and prioritize multiple complex issues throughout the workday in a flexible and professional manner
• Must work well, both independently and autonomously as well as cooperatively as a team member across multiple levels within the organization
• Recognizes need to escalate issues and seek guidance appropriately
• Results orientation - strives to meet business goals in an ever-changing healthcare environment
• Demonstrated proficiency in reviewing clinical and financial data
• Knowledge and experience in effective case management interventions and strategies across populations
• Demonstrates strong clinical and critical thinking abilities
• Well-developed analytic skills, problem solving, as well as written and verbal communication skills
• Sound computer and technological skills
• Skilled negotiator, influencing others – particularly those outside of direct reporting relationships
• Capable of effectively encouraging, supporting, motivating, and leading others
• Demonstrates collaboration in a way that boosts, promotes, and creates a positive work environment
• Willing to share constructive criticism and feedback in a supportive, sensitive, and patient manner
• Regard for confidential data and adherence to corporate compliance policy
• Must demonstrate commitment to excellence in customer service
• Considers creative alternatives to traditional/conventional practices and takes risk when appropriate to the situation
• Maintains the highest regard for confidential data and adherence to corporate compliance policy
• National Certification in Case Management is preferred
• BA/BS Degree
• Experience in managed care systems and operations is highly desirable and must demonstrate sound knowledge of care management principles
• 2-3 years of experience managing and leading a team
• Prior home care experience

Benefits

• Medical, dental and vision coverage
• Retirement plans
• Paid time off
• Employer-paid life and disability insurance with additional buy-up coverage options
• Tuition program
• Well-being benefits
• Full suite of benefits to support career development, individual & family health, and financial health

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