Manager, Clinical Care Case Management - Remote

Company Description

WHO IS GUIDEHEALTH? 

Guidehealth is a data-powered, performance-driven healthcare company dedicated to operational excellence. Our goal is to make great healthcare affordable, improve the health of patients, and restore the fulfillment of practicing medicine for providers. Driven by empathy and powered by AI and predictive analytics, Guidehealth leverages remotely-embedded Healthguides™ and a centralized Managed Service Organization to build stronger connections with patients and providers. Physician-led, Guidehealth empowers our partners to deliver high-quality healthcare focused on outcomes and value inside and outside the exam room for all patients. 

Job Description

The Manager, Clinical Care 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 Value Based clinical initiatives.  This includes but is not limited to case management, transitions of care, 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.  

WHAT YOU’LL BE DOING   

• Effectively managing day to day Health Plan Clinical Programs to enhance clinical efficiencies  
• Identifying opportunities for increased outpatient vs. inpatient utilization  
• Utilizing data provided to help in managing population health needs and implement population programs for Health Plan beneficiaries  
• Executing case management for patients identified at highest risk for adverse event or exacerbation, having the ability to impact, with the goal of decreasing unnecessary emergency department visits/hospitalizations  
• Overseeing an extended patient care team as assigned including but not limited to: Social Workers, Emergency Department Liaisons, Behavioral Health Liaisons, and Home Health Liaisons.  
• Overseeing 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.  
• Ensuring Quality Measures are reviewed and addressed when applicable/appropriate  
• Implementing and directing Health Plan Health Education Activities for beneficiaries, providers, and staff  
• Participating in Care Coordination and Quality Committees, Primary Care Provider Meetings, and other meetings as required  
• Monitoring corporate initiatives and strategies to achieve utilization of business and financial goals  
• Managing the successful integration of ACO Programs into current operations to meet the goals of all stakeholders  
• Maintaining collaborative relationships with business partners both within the company and the community  
• Managing and execute organizational opportunities and implement changes that are in alignment with corporate financial goals and strategic endeavors.  
• Managing departmental expectations: staff hiring, orientation, auditing, and reviews; time management; motivation; and performance improvement 
• Prioritizing of data, tasks, and requirements: Project management with expertise in departmental tasks and processes 
• Representing for health plan audits with development of actions plans for individual clients as needed to ensure compliance and incentive payouts 
• Overseeing all projects, productivity, daily tasks and PHM activities in an organized and efficient manner 
• Ensuring access to EMR systems for department staff  
• Monitoring staff maintenance of HIPPA regulations  
• Communicating with health plan contacts, customer Administrators and Client Business Managers to ensure resolution of any concerns.  
• Identifying and disseminating of Health Plan announcements applicable to Case Management 

Qualifications

WHAT YOU’LL NEED TO HAVE 

• RN/BSN required 
• 5 years of management experience 
• 4 years clinical nursing experience 
• At least 4 years of extensive experience in chronic care case management in outpatient setting 
• Certification in case management preferred 
• Must be able to work remotely and obtain state licensure in Illinois, Georgia, Pennsylvania, and Texas 
• Must feel comfortable and confident leading a team of certified but unlicensed personnel and Registered Nurse case managers 
• Ability to read, analyze, and interpret the most complex