Dual Eligible Special Needs Program Clinical Manager

US-LA-Metairie
Job ID
3525

Overview

Position Purpose

Dual Eligible Clinical Manager will organize and manage the daily operations of the Special Needs Plan (SNP) clinical program to ensure the effective planning and coordination in the assessment, care planning, and follow-up of the dual-eligible population through the SNP Interdisciplinary Care Team (ICT) process. The manager assists with implementation and monitoring of compliance with clinical policies related to the SNP; assists with implementation of regulatory requirements; and provides staff training support and performs other duties as outlined by the Clinical Director-SNP Program.

 

Scope of PositionThe Dual Eligible Clinical Manager provides oversight of staff engaged in initial and annual care planning for the SNP population.

Responsibilities

Principal Responsibilities

  1. Reports to the Clinical Director-SNP Program and has the management responsibilities of the SNP staff to include:
    • Dual Eligible RN Care Manager
    • Dual Eligible SW Care Manager
    • Dual Eligible Clerical Assistant(s)
  1. Manages the day-to-day work flow of the SNP staff; establishing work assignments, setting priorities, and ensuring completion of assignments within established time-frames.
  2. Provides clinical guidance in matters of assessment, care planning, documentation, provision of services, and care coordination.
  3. Attends all SNP ICT meetings, ensuring that the SNP care planning processes are followed, member reviews are comprehensive, and that the resulting care plans adequately address the member’s needs.
  4. Evaluates daily operations processes for adherence to documented processes, policies and procedures.
  5. Participates in evaluations of the quality and effectiveness of assessment and care planning to SNP population based on risk status.
  6. Participates in the ongoing evaluation of staff performance, as well as, participation in the annual performance appraisal process for all assigned staff.
  7. Coaches staff for the purpose of enhancing individual job performance.
  8. Contributes to the professional development of staff.
  9. Participates in the orientation and training of staff.
  10. Assists with the development of ongoing educational programs for staff.
  11. Identifies opportunities for process improvement and assists with development and implementation of new or revised processes.
  12. Maintains knowledge and understanding of all regulatory requirements related to assessment, documentation, and care planning for the SNP.

Management Responsibilities

  •  Monitors both department and individual staff performance, providing ongoing feedback
  • Maintains appropriate staffing levels required to meet departmental goals
  • Interviews candidates and makes hiring decisions as needed
  • Identifies opportunities for staff development and coordinates training as needed
  • Ensures staff members meet all required licensing, compliance and Eduneering requirements
  • Completes timely and thorough evaluations of staff
  • Functions as a mentor to staff regarding career goals within Peoples Health
  • Proactively manages employee relations issues, utilizing a progressive corrective action plan including appropriate documentation
  • Serves as a resource to other managers regarding issues that impact their departments
  • Develops, manages and works within department budget
  • Ensures compliance by maintaining knowledge of industry trends and legislation related to department
  • Ensures timely review and updating of departmental policies, procedures, training manuals and job descriptions as needed

Supervisory Responsibilities

 

  • Manages the daily work flow and operations of department including ensuring appropriate coverage
  • Handles escalated operational issues as needed and knows when to involve management
  • Assists manager in identifying appropriate staffing levels required to meet departmental goals
  • Identifies opportunities for staff development and works with management to coordinate/provide training as needed
  • Assists with development and maintenance of department training manuals
  • Plays an active role in staff training/development initiatives
  • Provides input to management regarding employees’ strengths and necessary improvement
  • Serves as a resource to staff and manager regarding issues that impact their departmentDirectly manages
  •  Directly Manages
    • Dual Eligible RN Care Manager
    • Dual Eligible SW Care Manager
    • Dual Eligible Clerical Assistant

Peoples Health Competencies

Every employee is expected to meet Peoples Health minimum requirements:

    • Commitment: to our Members: We have the power to change our members lives by placing them at the center of everything we do, everyday.
    • Action: By working together and delivering quality service, we enhance the lives of our members through dedication and teamwork.
    • Responsibility: To continue to strive to be the best for our members by adapting and evolving to change, continuing professional development, and to never stop learning.
    • Excellence: By exceeding expectations and finding innovative ways to exceed standards, we are changing our members’ lives.

Management Core Competencies

  •  Leadership – inspires and motivates others to perform well; leads by example.
  • Negotiation and Influential Ability – influences decisions in matters related to department to ensure corporate and departmental needs are satisfied
  • Management skills – includes staff in planning, decision-making, facilitating and process improvement; makes oneself available to staff, provides regular feedback, and develops staff’s skills - encouraging growth
  • Analytical/problem solving skills – identifies and resolves problems in a timely manner and gathers and analyzes information skillfully
  • Judgment – displays willingness to make decisions, exhibits sound and accurate judgment and makes timely decisions
  • Planning/organizational skills – prioritizes and plans work activities, uses time efficiently and develops realistic action plans
  • Oral/written communication skills – speaks and writes clearly and persuasively in positive or negative situations. Demonstrates group presentation skills when conducting meetings, leading a team or working with peers

Additional Competencies

 

  • Professionalism
  • Prompt and dependable
  • Sound clinical judgement, assessment, planning and care coordination skills
  • Expert skills in assessing clinical data and drawing conclusions
  • Ability to comprehend and adhere to policies and procedures
  • Expert skills in assessing clinical data and drawing conclusions.
  • Ability to comprehend and adhere to policies and procedures
  • Expert skills in interviewing, assessing, and communicating effectively with members who have varying levels of education.
  • Positive attitude related to change and the ability to easily adapt.
  • Display a high level of integrity and respect for confidentiality, and adhere to regulatory and PH policies and procedures.
  • Strong interpersonal, planning, organizational, communication, and decision making skills.
  • Ability to collaborate effectively with others in planning, problem solving, and completing work assignments.
  • Exceptional attention to detail.
  • Ability to meet deadlines under pressure.
  • Ability to effectively direct staff, manage conflict, and resolve issues.
  • Manages time appropriately, efficiently, and effectively.
  • Ability to read, comprehend, and apply information written at a college level.
  • Appreciation for diversity of work styles.
  • Effective listener.
  • Ability to effectively interact with multifaceted medical professional staff.

Qualifications

Experience/Education

  • Required-
    • Diploma or degree in nursing
    • 3-5 years’ experience in clinical or similar setting
    • Experience with clinical documentation systems
    • Experience in assessing members and developing care plans
    • Strong organizational skills, attention to detail, verbal and written communication skills
  • Preferred
    • Bachelors in Nursing
    • Peoples Health employee for one (1) year
    • 1-3 years supervisory experience
    • Experienced in management care industry
    • Familiarity with NCQA SNP structure and process measures and CMS Medicare managed care regulations
    • Understanding of HMO and third-party administration
    • Continuing education in the healthcare/managed care industry

 Licensure/Certification

Current Louisiana RN license required

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