Job Description

In this position you will lead this department in meeting their care management goals. The team is responsible for outreach to select patients identified by Blue Cross Blue Shield through ICD 10 codes, readmissions and frequency of ER visits. This role is responsible for project management and supervision of the Case Managers. and you will work to meet the Key Performance Indicators around program enrollment.

WHAT YOU’LL BE DOING

• Managing departmental expectations including staff hiring, orientation oversight, auditing, and reviews; time management; motivation; and performance improvement
• Creating and monitoring of KPIs and metrics to ensure levels of service are met.
• Serving in project management and delegation of duties to ensure coverage for all tasks
• Prioritizing of data, tasks, and requirements.
• Representing Guidehealth for BCBS audits with development of actions plans for each individual IPA to ensure compliance and incentive payouts
• Overseeing all projects, 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 IPA Administrators and Client Business Managers to ensure resolution of any concerns.
• Identifying and disseminating of Health Plan announcements applicable to Population Health

Qualifications

WHAT YOU’LL NEED TO HAVE

• Registered Nursing Degree from an accredited school with 5+ years management experience in a Care Management setting.
• 5+ years of related work experience managing a dynamic, high performing team.
• Knowledge set including: project management, team management, evidenced based practices, social determinants/barriers of health, motivational interviewing, and goal setting
• Experience working with complex data sets
• Healthcare data experience

WE'D LOVE FOR YOU TO HAVE

• Experience in a fast paced, rapidly growing company.
• In depth knowledge of TPA’s, CMF’s, health plans and Medicare Advantage with ability to decipher meanings and identify changes
• Knowledge of national guidelines and care trends/incentives, crossovers with quality, and insights to analytics

Additional Information

The salary for this role is $95,000.00 per year.

BENEFITS:

All full-time employees of Guidehealth who work 30 hours per week or more are eligible for our comprehensive benefits package. While you are hard at work advancing value-based healthcare, we are here to ensure YOU have the care you and your family need and the opportunities for growth and development. Our commitments to you include:

• Work from Home: Guidehealth is a fully remote company, providing you the flexibility to spend less time commuting and more time focusing on your professional goals and personal needs.
• Keep Health a Priority: We offer comprehensive Medical, Dental, and Vision plans to keep you covered.
• Plan for the Future: Our 401(k) plan includes a 3% employer match to your 6% contribution.
• Have Peace of Mind: We provide Life and Disability insurance for those "just in case" moments. Additionally, we offer voluntary Life options to keep you and your loved ones protected.
• Feel Supported When You Need It Most: Our Employee Assistance Program (EAP) is here to help you through tough times.
• Take Time for Yourself: We offer Flexible Time Off tailored to meet your needs and the needs of the business, helping you achieve work-life balance and meet your personal goals.
• Support Your New Family: Welcoming a new family member takes time and commitment. Guidehealth offers paid parental leave to give you the time you need.
• Learn and Grow: Your professional growth is important to us. Guidehealth offers various resources dedicated to your learning and development to advance your career with us.

COMPENSATION:

The listed compensation range listed is paid bi-weekly per our standard payroll practices. Final base pay decisions are dependent upon a variety of factors which may include, but are not limited to: skill set, years of relevant experience, education, location, and licensure/certifications.

OUR COMMITMENT TO EQUAL OPPORTUNITY EMPLOYMENT

Diversity, inclusion, and belonging are at the core of Guidehealth’s values. We are an equal opportunity employer. We enthusiastically accept our responsibility to make employment decisions without regard to race, religious creed, color, age, sex, sexual orientation and identity, national origin, citizenship, religion, marital status, familial status, physical, sensory, or medical disability, Family and Medical Leave, military or veteran status, pregnancy, childbirth or other related medical conditions, or any other classification protected by federal, state, and local laws and ordinances. Our management is fully dedicated to ensuring the fulfillment of this policy with respect to hiring, placement, promotion, transfer, demotion, layoff, termination, recruitment advertising, pay, and other forms of compensation, training, and general treatment during employment.

OUR COMITTMENT TO PROTECTION OF PATIENT AND COMPANY DATA

This position is responsible for following all Security policies and procedures in order to protect all PHI and PII under Guidehealth’s custodianship as well as Guidehealth Intellectual Properties. For any security-specific roles, the responsibilities would be further defined by the hiring manager.

REMOTE WORK TECHNICAL REQUIREMENTS

Guidehealth is a fully remote company. We provide new employees with the necessary equipment to function in their role at no charge to the employee. Employees provide their own internet connection, capable of conducting video calls on camera and connecting to various internal and external systems. The recommended internet speed is a minimum of 50 mbps download, 10 mbps upload. Please consult with your internet provider or run a speed test here to confirm your internet connection meets these requirements.