Care Management RN Manager (MN Licensed)

Position Responsibilities

• Specific Design Care Management/ Population Health programs and processes to meet current strategic needs and in anticipation of future state innovation
• Design/ implement overall department structure such that a) staffing is appropriate and cost-effective; b) technology use is maximized; and c) staff and operational performance standards are met or exceeded
• Design, develop and facilitate understanding, adoption and compliance with Model of Care
• Ensure vendors meet obligations and fulfill contractual requirements
• General Provide support for health plan market/ product level operational oversight, management and performance improvement
• Leverage industry expertise and knowledge to provide high value consulting and advisory services
• Deliver integrated solutions in support of client goals and engagements
• Support engagements ensuring completion of contracted services
• Create and/ or manage to project plans
• Prepare materials for presentation to Client executives
• Facilitate and inform key decisions through the use of data and industry best practice sharing
• Deliver concise, clear interpersonal communication to both internal and external audiences
• Facilitate streamlined exchange of information with engagement manager and client organization partner(s)
• Leverage proven methodologies and best practices in support of individual account strategies/ client plans
• Establish goals and track progress to ensure achievement
• Act in interim leadership capacity to provide supervision and oversight for teams and activities in a direct supervisory model
• Identify opportunities to improve workflow, generate accurate, high-quality productivity, support organizational compliance with requirements and deliver reductions in associated costs with improvement in organizational quality performance in collaboration with Client leaders
• Develop or update policies and procedures as required to support business needs and requirements
• Identify opportunities to streamline and/ or automate workflows
• Manage and develop staff to reach established engagement goals, deliverables and KPIs
• Adapt processes, approach, plan and/ or activities in real time to ensure critical path activities are achieved
• Support account management relationships with key client decision makers
• Develop and deploy management reporting, if indicated, to support monitoring and improvement of performance, implementing plans for improvement as necessary
• Responsible for ensuring quality, maintaining appropriate resources, competency training and education of staff
• Responsible for approving and managing day to day engagement resourcing/ time and attendance as an Engagement Manager
• Oversee compliance with internal client related audits, support Client preparation for external audits and surveys

Position Qualifications

• Experience managing complex work in challenging environments through the alignment of resources and prioritization of efforts to ensure on time, in scope project and/ or strategic delivery
• Managed care industry knowledge in operations, costs, requirements, performance and outcomes
• Product/ market operational experience in Commercial, Medicare, Medicare Advantage, Medicaid or associated lines of business
• Understanding of legal and regulatory frameworks, healthcare administration models, and internal audit procedures
• Understanding of key regulations, frameworks, accreditation and oversight bodies to ensure compliance with complex regulatory structures
• Knowledge of project management principles, methods, and techniques
• Strong communication skills both written and oral
• High proficiency with core office software (Excel, Word, and PowerPoint). Visio skills preferred
• Experience Bachelors Degree in Nursing or other affiliated health care discipline required, Master’s Preferred
• Registered nurse with current unencumbered MN license
• Experience in clinical leadership in a Managed Care environment
• Experience working with vulnerable populations helpful, knowledge of health disparities highly desired
• Experience managing an interdisciplinary care team in a fast paced, time-sensitive environment
• 2+ years progressive experience in managed care at the Manager level or equivalent level, preferably in a government payor environment