ACO Care Manager

Description

The estimate displayed represents the typical wage range of candidates hired. Factors that may be used to determine your actual salary may include your specific skills, how many years of experience you have and comparison to other employees already in this role. The typical candidate is hired below midpoint of the range.

Introduction

Do you have the career opportunities as a(an) ACO Care Manager you want with your current employer? We have an exciting opportunity for you to join HCA Healthcare which is part of the nation's leading provider of healthcare services, HCA Healthcare.

Benefits

HCA Healthcare, offers a total rewards package that supports the health, life, career and retirement of our colleagues. The available plans and programs include:

• Comprehensive medical coverage that covers many common services at no cost or for a low copay. Plans include prescription drug and behavioral health coverage as well as free telemedicine services and free AirMed medical transportation.
• Additional options for dental and vision benefits, life and disability coverage, flexible spending accounts, supplemental health protection plans (accident, critical illness, hospital indemnity), auto and home insurance, identity theft protection, legal counseling, long-term care coverage, moving assistance, pet insurance and more.
• Free counseling services and resources for emotional, physical and financial wellbeing
  
• 401(k) Plan with a 100% match on 3% to 9% of pay (based on years of service)
  
• Employee Stock Purchase Plan with 10% off HCA Healthcare stock
  
• Family support through fertility and family building benefits with Progyny and adoption assistance.
  
• Referral services for child, elder and pet care, home and auto repair, event planning and more
  
• Consumer discounts through Abenity and Consumer Discounts
  
• Retirement readiness, rollover assistance services and preferred banking partnerships
  
• Education assistance (tuition, student loan, certification support, dependent scholarships)
  
• Colleague recognition program
  
• Time Away From Work Program (paid time off, paid family leave, long- and short-term disability coverage and leaves of absence)
  
• Employee Health Assistance Fund that offers free employee-only coverage to full-time and part-time colleagues based on income.

Learn more about Employee Benefits

Note: Eligibility for benefits may vary by location.

Our teams are a committed, caring group of colleagues. Do you want to work as a(an) ACO Care Manager where your passion for creating positive patient interactions are valued? If you are dedicated to caring for the well-being of others, this could be your next opportunity. We want your knowledge and expertise!

Job Summary and Qualifications

GENERAL SUMMARY OF DUTIES:

The Managers primary function is to develop and implement accountable care programs which meet contractually identified targets for efficiency and quality. The programs will be designed to implement interventions which will subsequently prevent unnecessary admissions, readmissions, and overutilization in a healthcare system, to meet the Triple Aim of better care, better health, and lower costs. The Manager initiates and coordinates a multi-disciplinary team approach to case management across the care continuum to ensure timely and appropriate access to care. The Manager will effectively manage patients at high risk for healthcare complications to help improve their quality of life.

DUTIES INCLUDE BUT NOT LIMITED TO:

CLINICAL PROGRAM MANAGEMENT

1. Work with payors and other identified organizations to develop and implement accountable care and chronic disease management programs, in accordance with contractual requirements.

2. Track, improve and provide and executive level summaries regarding the coordination, utilization, quality and cost of patient care, and the patient experience.

3. Track, improve and report results for identified efficiency measures including but not limited to readmits, ER Visits, ASU, Radiology, Lab, Surg/Med bed days, gaps in care, and generic prescribing.

4. Review utilization reports provided by the payors and provide executive level summaries to the medical management team.

5. Work with team members, both internally and externally, to provide accountable program results, enrollment information and required data elements.

6. Participate in accountable care management meetings, both internally and externally, as required.

7. Attend accountable care training sessions, as required.

8. Work with the PPMSI medical management team to develop tools and methods of identifying high risk patients using payor information as well as in-house analysis.

9. Work with the Medical Management team to develop tools and methods of identifying high risk patients using payor information as well as in-house analysis.

10. Ensure targeted high risk chronically ill patients are enrolled in care management programs according to program requirements.

11. Coordinate efforts with the Quality Management team to meet quality gate targets for identified patients, as required by the accountable care programs.

12. Assume responsibility for special projects as assigned by the Medical Director.

CARE MANAGEMENT

1. Initiate and coordinate a multidisciplinary team approach to case management which includes patients, payors, and providers, across the care continuum.

2. Evaluate patients comprehensive medical and social support and devise a comprehensive plan of care to support patients self-management of condition(s), arrange for services and ensure continuity of care at optimal levels.

3. Design care plans which ensure seamless continuity of care, minimize the potential for duplication of services, and reduce fragmentation and gaps in care.

4. Enhance and continuously improve communication and collaborative relationships with multi[1]disciplinary healthcare team members including payors and providers.

5. Act as a patients advocate protecting privacy and confidentiality issues.

6. Provide patient education, monitor health needs, and coordinate community resources.

7. Prevent adverse patient events to minimize poor outcomes.

8. Maintain a comprehensive working knowledge of community resources, payor requirements, and network services available to the target population.

9. Identifying opportunities for health promotion and illness preventions.

TRAINING AND EDUCATION

1. Train case mangers on all aspects of the accountable care programs they administer.

2. Develop materials and train providers and their staff on accountable care programs emphasizing communication, coordination, collaboration and accountability.

3. Liaise with the Quality Management and Network Management teams to develop program awareness.

SKILLS

1. Advocacy, communication, education and counseling, and resource research skills.

2. Core philosophy or values consistent with a family-center approach to care.

3. Culturally effective capabilities demonstrating a sensitivity and responsiveness to varying cultural characteristics and beliefs.

4. Perform other duties as assigned.

KNOWLEDGE, SKILLS AND ABILITIES:

This position requires the following minimum requirements:

• Experience and competence with Microsoft Office( Excel, Word, Powerpoint) and internet-based software tools
• Excellent written, verbal, telephonic skills
• Excellent data gathering, data analysis and summary-level reporting skills
• Effective supervisory and leadership skills; team building, problem solving, ability to motivate staff and ability to train staff
• Ability to prioritize tasks and thrive in a highly productive environment
• Ability to communicate effectively, both verbally and in writing, with executive clinical and non[1]clinical leadership, payor representatives and providers and their office staff
• Strong professional level of knowledge and comprehensive clinical assessment skills in the areas of population and chronic disease management
• Familiar with current clinical practices for adult and pediatric medical, surgical and psychiatric cases
• Familiar with standard review criteria such as Interqual and/or Milliman
• Attention to detail
• Ability to manage conversations with tact and diplomacy
• Ability to become proficient with case management information technology

• EDUCATION:

  Current unrestricted California RN Licensure required

  EXPERIENCE:

  Minimum of 3 years of previous experience in a managed care organization or other comparable experience required

• Registered Nurse, or Licensed Practical / Vocational Nurse (LPN / LVN)

No Travel Required

3 years experience Required Years of Experience

Physician Services Group is skilled in physician employment, practice and urgent care operations. We are experts in hospitalist integration, and graduate medical education. We lead more than 1,300 physician practices and 170+ urgent care centers. We are HCA Healthcares graduate medical education leader. We provide direction for over 260 exceptional resident and fellowship programs. We focus on carrying out value-added solutions. These solutions help physicians deliver patient-centered healthcare. We support HCA Healthcare's commitment to the care and improvement of human life.

HCA Healthcare has been recognized as one of the Worlds Most Ethical Companies by the Ethisphere Institute more than ten times. In recent years, HCA Healthcare spent an estimated $3.7 billion in cost for the delivery of charitable care, uninsured discounts, and other uncompensated expenses.

'Bricks and mortar do not make a hospital. People do.'- Dr. Thomas Frist, Sr.
HCA Healthcare Co-Founder

If you are looking for an opportunity that provides satisfaction and personal growth, we encourage you to apply for our ACO Care Manager opening. We promptly review all applications. Highly qualified candidates will be contacted for interviews. Unlock the possibilities and apply today!

We are an equal opportunity employer and value diversity at our company. We do not discriminate on the basis of race, religion, color, national origin, gender, sexual orientation, age, marital status, veteran status, or disability status.