The purpose of this position is to be responsible for supporting cost-effective, high-quality health care for patients enrolled in the long-term care facilities in their region by managing the activities of a team of Providers and supports national clinical strategy and leadership. The Program Manager is responsible for conducting clinical audits of the providers to ensure excellent service deliver, and that care is administered in accordance with Medicare, Medicare Advantage, and all other compliance programs, state laws and regulatory compliance, privacy and security, detecting, preventing, and correcting fraud, waste, and abuse.
Description of Required Duties and Tasks:- Works closely with the leadership at the long-term care facilities in their region and company leadership to meet the key performance metrics for a market
- Directly manages a team of Providers and RN Case Managers who are providing care in nursing facilities
- Ensures all patient services are delivered on time and effectively and within the scope of the plan.
- Collaborates with colleagues to explore innovative delivery models or enhancements to current delivery models and care practices.
- Identifies opportunities for process improvements and staff education to produce optimal outcomes
- Serves as a subject matter expert (SME) on the ISNP plan and care model.
- Collaborates on the development of training materials to support clinical training
- Participates in clinical training initiatives
- Collaborates with business leaders to implement new markets and programs
- Reviews daily, weekly and monthly management reports to monitor and manage care delivery.
- Collaborates with vendors and community organizations for improved service delivery
- Oversees the review and resolution of complaints and grievances
- Participates in company-wide initiatives to ensure consistency and high-quality in the clinical delivery of care
- Participates in company-wide quality improvement initiatives across all aspects of the organization
Required Skills/Education/Experience:- APRN or PA license required
- 3-5 Years of experience in long term care or chronically ill patients
- 3-5 years of practice experience needed
- 1-3 years of management experience in long term care, home health or chronic condition management preferred
- Driver's license without restrictions and good driving record
- Working knowledge of MS Office including Word, Excel, PowerPoint, SharePoint, and Visio
- Strong experience in leadership and business preferred.
- Strong background and familiarity with Medicare, Medicaid, ISNP, Nursing Facility and Managed Care preferred
- Strong working knowledge of HEDIS/ STARs preferred
Supervisory Responsibilities:- First line supervision and delegation of duties of all the Providers (NPs/PAs) and RN Case Managers in direct clinical care services
- Frontline oversight, planning, and delegation of onboarding activities of new employees within the designated region
- Responsible for provider relations issues that are not at a regional or corporate level that would affect P&Ps
