Manager, Specialized Programs and Products
Manages the day-to-day activities of one or more of the Population Health specialized programs or products. Ensures the integration of evidence-based care practices into protocols, policies, consultation strategies, and continuous quality improvement initiatives. Supervises the team to ensure patients/members in the program meet eligibility requirements and appropriateness. Works in tandem with Health Plans to ensure appropriate services are put in place when criteria is met. Works under general supervision.
Manages the day to day activities of specialized programs and/or products. Establishes workflows and protocol, assesses effectiveness, and makes recommendations for improvements, as needed.
Acts as liaison for care management teams to ensure the program is meeting expected outcomes; implements changes as necessary.
Initiates, leads, and/or participates in internal and external clinical care conferences. Acts as a resource for care managers in the coordinating care. Promotes staff understanding of tele-management process and its value for patients/members, medical providers, health care partners and the organization. Maintains excellent communication and relationships with home care/hospice teams and Health Plans.
Assesses, educates, and improves patient/member knowledge of chronic disease, self-care management and identification of changes in health status, including appropriate responses and actions through individualized education and multifaceted interventions.
Reviews VNSNY patient records for cases that were readmitted during an active home care episode. Leads and coordinates the root cause analysis of the readmission event in collaboration with VNSNY operations and helps to develop recommendations for quality improvement measures.
Reviews productivity reports; analyzes trends and key findings in conjunction with management. Implements corrective measures to address any performance or operational issues.
Conducts team audits on a routine basis in accordance with departmental policy.
Assists staff in both in home care and health plans in the navigation of the patient/member, family, physician, and home care team through education, evaluation, and decision making, as needed.
Oversees metric reporting and works with the Business Operations in the creation of weekly departmental KPI reports.
Assists senior leadership with development of VNSNY client outcomes reporting and other analyses of clinical data and VNSNY quality reporting as needed.
Performs all duties inherent in a managerial role. Ensures effective staff training, interviews candidates for employment, evaluates staff performance and conducts annual performance appraisal, and recommends hiring, promotions, salary actions, and terminations, as appropriate
Participates in special projects and performs other duties as required.
For Care Management Case Rate only:
Troubleshoots and resolves escalated problems that arise within clinical utilization management/case rate operations. Identifies trends and makes recommendations to management to take corrective action to remedy issues.
Oversees clinical utilization to ensure visits are made according to episode utilization guidelines and clinical outcomes best practices. Develops/revises utilization policies and practices based on analysis of past practices to improve utilization.
Collaborates with health plans to design and implement programs for hospital avoidance.
For Advanced Illness only:
Initiates conversations with the home care team/Health Plan regarding the potential need for Advanced Care Illness Planning.
Identifies potential barriers to Hospice and Palliative Care once member/patient agrees to advanced illness care. Follows up with clinical operations to communicate identified barriers and recommended interventions, as appropriate.
Leads huddles with team members to review status and qualifying criteria of cases in workflow; coordinates standard follow-up with both internal and external Hospices for referred cases.
For Specialized Products only:
Works with partners/vendors to ensure devices are set up appropriately in patient/member setting Works with patient/member to troubleshoot basic technical problems with device and escalates technical issues to the Remote Patient Monitoring (RPM) team when necessary.
Works with leadership on the implementation and usage of technologies across the care management organization.