Medical Management Team Lead, Maternal-Child occupation at Neighborhood Health Plan of Rhode Island in Providence

Neighborhood Health Plan of Rhode Island is currently seeking to employ Medical Management Team Lead, Maternal-Child on Tue, 15 Oct 2013 23:46:23 GMT. The Team Lead of Medical Management provides oversight for specific care management or medical review programs/activities and works collaboratively with the Health Care Team to manage and coordinate care in order to ensure quality, and cost-effective patient-centered care. Qualifications: Required: - BS, any disciplinary - RN , licensed in the State of Rhode Island - Supervisory skills - Broad...

Medical Management Team Lead, Maternal-Child

Location: Providence, Rhode Island

Description: Neighborhood Health Plan of Rhode Island is currently seeking to employ Medical Management Team Lead, Maternal-Child right now, this occupation will be dwelled in Rhode Island. More complete informations about this occupation opportunity please give attention to these descriptions. The Team Lead of Medical Management provides oversight for specific care management or! medical review programs/activities and works collaboratively with the Health Care Team to manage and coordinate care in order to ensure quality, and cost-effective patient-centered care.

Qualifications:
Required:

• BS, any disciplinary
• RN , licensed in the State of Rhode Island
• Supervisory skills
• Broad clinical experience with special needs and with chronic medical conditions
• Experience with medical care management
• Knowledge of medical, behavioral health and social services systems of care for individuals with special health care needs including disease management principles
• Computer literacy with Windows based programs
• Strong organizational and documentation skills
• Excellent customer service orientation
• Strong interpersonal skills
• Strong consumer advocacy skills
• Strong verbal and written communication skills
• Demonstrated ability! to work as a part of a multi-disciplinary team
• Flexi! bility to work some evening hours

Preferred:

• 5 or more years of experience in health care (HMO) and case management
• 10 or more years Clinical experience
• Case management certification
• Bilingual (English/Spanish), bilingual a plus

Duties and Responsibilities:Responsibilities include, but are not limited to:

• Manage staff scheduling functions including daily assignments, coverage issues, time off requests, attendance monitoring, and payroll authorization
• Coordinate day-to-day operational activities for team
• Cross coverage for other Medical Management Team Leads as needed
• Assist in settings performance standards and productivity measures
• Monitor program statistics, compliance and adherence to performance standards
• Assist Manager with development and design of new programs as assigned
• Provide direct oversight and serve as a clinical! resource to the Medical Management Team in making case management care coordination and appropriateness of care recommendations/decisions
• Assist manager in identifying educational opportunities for staff
• Support Manager in completion of the performance review process and implementation of staff development plans
• Monitor clinical outcomes and assists manager in evaluating outcomes
• Coordination of orientation for new staff in medical management
• Ensure comprehensive training of new staff including supervising home visits as required
• Communicate with staff via one-on-one meetings as delegated by manager
• Recommend opportunities for improvement in care coordination operational processes for assigned programs
• Assist manager in development and revision of specific policies and protocols
• Serve as primary contact at Neighborhood for Providers, families and other community resources, as assigned
Serve as Liaison to community resources, as needed
• Represent ! Medical Management on committees and in external marketing and education presentations as assigned by Manager
• Participate and assist with performance measures, quality improvement activities and regulatory requirements
• Take responsibility for own professional development and competency requirements
• Other duties as assigned by the Manager

Specific to Maternal Child Care Management Team Lead:

• Utilize case management principles and sound clinical judgment in coordinating care for members with special health care needs
• Perform intensive case management functions for identified individuals when needed in order to promote quality, cost-effective outcomes, including:
• Performing a comprehensive assessment
• Conducts home visits if required
• Care planning activities including the development of interventions, short and long-term goals in collaboration with member, family, PCP, and other involv! ed health care professionals and community agencies, as appropriate
• Implementation of the defined plan of care, and facilitation of the referrals and coordination of services and community resources
• Continuous monitoring and evaluation of the care outcomes and identification of service gaps
• Regular review and revision of the plan of care in collaboration with the family and appropriate members of the health care team based on the outcomes and evaluative findings
• Provide comprehensive documentation of all Care Planning and resource management activities in the case management software system
• Coordinates medical and behavioral health services
• Works collaboratively with all health care agencies
• Works collaboratively with Beacon Health Strategies, EOHHS, DHS, DOH and other designated entities
• Standard owner for Complex Case Management QI-7
• CEDARR Family Centers point of contact
• Communicate! s with other departments as well as external providers as necessary
• External meetings with designated entities
• Monthly supervisory meetings with staff for review of work and process improvements
• Conduct multi-disciplinary case conferences monthly
• Point person for Qualidigm (contractor with EOHHS) for Neonatal ICU management
• Point person for the Myers Group for Case Management Satisfaction
• Responsible for multiple programs including: Pediatric Case Management, Neonatal Case Management, Bright Start Case Management, Synagis Care Coordination, Transplants, Transitions of Care, and the Transition Home Plus Program with Woman & Infants Hospital.
• Coordinates day to day activities of Maternal Child Programs including: Mentoring and Coaching of staff
• Daily oversight of staffing and assignments to ensure appropriate coverage and distribution of responsibilities
• Assists in coordination of orientation for new staff in Maternal Child Programs;
• Provides instruction to! peers, to clarify procedures, ensure accuracy and promote quality
• Serves as Clinical resource to Maternal Child team
• Attends and participates in external marketing and education presentations as assigned
• Participates and assists with Performances Measures and Quality Improvement activities
• An essential responsibility of all Neighborhood employees is to comply with all applicable law, rules, regulations, policies and procedures. We expect all employees to act with the highest ethical standards and integrity.
• Meets department and regulatory standards for accuracy, proficiency and documentation in order to communicate decisions and plan of care in an appropriate and timely manner
• Takes responsibility for professional development, supports a learning environment, and meets professional competency requirements

Neighborhood is an EOE M/F/D/V and an E-Verify Employer.
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If you were eligible to this oc! cupation, please give us your resume, with salary requirements and a re! sume to Neighborhood Health Plan of Rhode Island.

Interested on this occupation, just click on the Apply button, you will be redirected to the official website

This occupation starts available on: Tue, 15 Oct 2013 23:46:23 GMT

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