RN Manager – Delegation Compliance

RN Manager – Delegation Compliance

Requirements

• Bachelor’s in Nursing
• Active RN license within one or more OSH states
• Willingness to obtain cross-state licensure, as needed
• 5+ years of healthcare experience, preferably in a primary care and/or managed care setting
• 2+ years direct supervisory experience
• Certified Case Manager (CCM) or equivalent case management certification required, or willingness to obtain within 12 months of hire
• Knowledge of Medicare/Medicaid and NCQA requirements
• Practical and operational experience in a managed care environment, preferably with working knowledge of related legal/regulatory/health plan requirements
• Demonstrated experience leading teams, competence with change management, and leading process improvement
• Knowledge relating to healthcare delivery workflows, project management, and quality improvement is required
• Strong teamwork and interpersonal skills. Must be able to work effectively with cross-functional groups, fostering teamwork with a commitment to quality
• Passion for excellence, willing to go the extra mile to achieve objectives and ensure consistently high quality work product
• Ability to succinctly summarize and synthesize large amounts of information
• Quick learner comfortable with a high level of ambiguity
• Strong accountability and discipline against timelines and deliverables
• Strong clinical and assessment skills
• Outstanding verbal and written communication skills
• Ability to work independently and maintain flexibility in a fast-paced, start-up environment
• Self-starter with a high level of accountability and responsibility for the outcome of care
• Highly organized and able to manage multiple priorities appropriately
• Independent problem-solving skills
• Able to work collaboratively and build enduring relationships with providers, patients and the multidisciplinary team.
• A flexible, positive attitude
• Proficient with Microsoft Office, Google Suite, and healthcare EMRs
• US work authorization

Responsibilities

• Oversee compliance for UM and CM to deliver an unmatched patient experience and ensure delegation compliance.
• Audit individual charts according to QA Audit Protocols to ensure compliance with program responsibilities and best practices
• Possess knowledge of contractual, accreditation, federal and business requirements for assigned program and ensure compliance with program requirements and develop corrective action plans as needed
• Establish work procedures and processes that support the company and departmental standards, procedures and strategic directives
• Establish workflows that meet compliance requirements and align with organization-wide clinical protocols
• Lead the review of policies and procedures, program descriptions, and evaluations;
• Conduct training for new team members and other internal parties as required
• Provide statistical and performance feedback, and coaching on a regular basis to each team member in their assigned region
• Create and maintain a high-quality work environment so team members are motivated to perform at their highest level
• Provide continual evaluation of processes and procedures. Responsible for suggesting methods to improve area operations, efficiency, and service to both internal and external staff
• Collaborate with other OSH program leaders to implement initiatives in support of integrating delegated services with core OSH care model (e.g. care team, social work, behavioral health, utilization management, patient engagement, central telehealth, etc.) to promote patient outreach and engagement and identify and address patient needs.
• Serve as point of contact for / management of health plan relationships related to delegated care management
• Oversight of delegated entities and internal operating partners servicing Care Coordination, including management of operational performance and program execution
• In partnership with Business Intelligence, set, implement and monitor system configuration requirements in accordance with operational and regulatory specifications required for new programs
• Complete report submissions, including validation where needed
• Other duties as assigned

Preferred Qualifications

• Prior experience in a similar role at an IPA, Health Plan or MSO will be advantageous