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Director, Case Management Services

Company: Providence Community Health
Location: Providence
Posted on: November 26, 2022

Job Description:

Providence Community Health Director, Case Management Services Employee - Full Time Leadership-Director Beaman and Smith, 1st Floor, Providence, RI, US Under the general supervision of the Accountable Care Medical Director, and in collaboration with the our Patient-Centered Medical Home Team-certified provider groups, the Director of Case Management Services is responsible for: providing comprehensive screening, assessment, care coordination services, disease education, and self-management support to moderate to high-risk patients with complex chronic health or behavioral health conditions.ESSENTIAL DUTIES AND RESPONSIBILITIESComplies with federal and state regulatory agencies as well as contractual obligations to various payers with regards to AE and Patient-Centered Medical Home guidelines and program measuresProvides design and development concepts of AE Care Management activities related to care coordination, transitions of care, and centralized care management's integration into primary care team processesDevelops and continuously seeks to improve the medical home teams to provide effective and efficient health care through the use of health information technology and analytical reportsCompetent in the use of the EHR and designated as a "super user" (Epic Healthy Planet as of 10/2023)Researches, develops and helps to implement standards of care in the area of Case Management and throughout the agencyMaintains NCQA Care Management certification or similar as required for all delegated care management contractsCommunicates the goals and barriers to patient outcomes in the populations served by complex care managementManages care management employee processes and outcomes for optimal impact on quality and patient outcomesEDUCATION AND/OR EXPERIENCE:Bachelor's degree in nursing preferred, any Bachelor's Degree required. Current Rhode Island RN license preferred. CPR required. Master's or significant course work towards a Master's in Nursing or Public Health preferred.Three to five years of experience in community health setting, public health, chronic disease management, community nursing, case management preferred.Ability to perform duties and responsibilities across life cycle (infants, children, adolescents, adults, prenatal, and geriatric). Bicultural (Spanish) skills and Bilingual experiences valuedExperience in providing managed care patient services. Commitment to work in community health with the challenges of a high risk, and often uninsured and diverse patient population required.Understanding of basic statistical measurement such as mean, median, and standard deviationsComputer proficiency in Microsoft Office requiredAbility to develop effective interpersonal relationships with the health care team, providers as well as management staff.Proven writing skills to develop protocols, policies and procedures, required.Strong/demonstrated communication skills, written and verbal, required.Ability to function as a "champion for change."Ability to motivate staff/teams and simultaneously manage several projects.Demonstrated presentation skills and strong interpersonal skills.Understands revenue cycle operations.Ability to work independently and manage a large volume of casesExperience in medical care coordination and chronic disease management.Experience in working with primary care providers in practice setting to coordinate care and disease managementKnowledge of medical case management, disease management, and chronic care principlesExperience working in a Patient-Centered Medical Home environment, preferred.Proficiency using EHR required.Knowledge of HIPPA regulations.Access to reliable transportationPCHC is EOE/M/F/D/V/SOPI197618270

Keywords: Providence Community Health, Providence , Director, Case Management Services, Executive , Providence, Rhode Island

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