Manager Population Health - Sharp Health Plan Member Services - Day Shift - Full Time

Hours:

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On-Call Required:

Hourly Pay Range (Minimum - Midpoint - Maximum):

The stated pay scale reflects the range that Sharp reasonably expects to pay for this position.  The actual pay rate and pay grade for this position will be dependent on a variety of factors, including an applicant’s years of experience, unique skills and abilities, education, alignment with similar internal candidates, marketplace factors, other requirements for the position, and employer business practices. 

What You Will Do
The manager plans, directs, and coordinates the development and implementation of the ambulatory Population Health patient programs and services consistent with the mission of Sharp HealthCare and Sharp Health Plan. Population-based programs include but are not limited to coordinated services that target members identified with rising risk or at high risk for adverse health outcomes, and utilize condition-specific targeted interventions, disease management, case management or complex case management services to help mitigate risk and improve the health of the population at large. Population Health program engagement, performance, and outcomes are measured for continuous quality improvement and align with organization-wide targets for initiatives such as National committee for Quality Assurance (NCQA); AlignMeasurePerform (AMP); Pay for Performance (P4P) metrics; Medicare Stars; HEDIS; Performance Guarantees and metrics; and other quality measurement program measures. The manager prepares, plans and is accountable for all aspects of the Population Health program for services that meet the health care needs of the patient population including collaborative efforts with internal and external stakeholders such as marketing, finance, pharmacy, customer service, delegated providers, compliance, wellness, and other areas as appropriate or necessary optimal program management.

With the Director, the Chief Medical Officer (CMO), Medical Directors and other SHP Managers/Directors, the manager determines direction, goals, and objectives of the Population Health Program and department; and develops linkage to appropriate departments, delegated providers, hospitals, physicians, or administrative personnel for implementation of strategic plans. In a multidisciplinary approach, functions as clinical expert, consultant, educator, researcher/evaluator. Supports senior leadership in achieving high quality of service in an efficient and economic manner within assigned areas of responsibility. Ensures quality outcomes for all services and strives to improve the performance of the team members.

Provides direct management of the PHM and CM teams and serves in a leadership role for department. Models' effective leadership and mentoring skills for the department clinical and non-clinical staff. Promotes staff development, provides the necessary mentoring skills using the concepts and tools supporting the 'Sharp Experience'.

Ensures department adheres to and maintains regulatory and legislative compliance from CMS, NCQA, DMHC, and other regulatory bodies related to PHM, CCM and DM.

Required Qualifications

• Master's Degree in Nursing
• 3 Years Case management experience.
• 5 Years experience in a leadership role.
• California Registered Nurse (RN) - CA Board of Registered Nursing -REQUIRED

Preferred Qualifications

• 2 Years Health Plan or Medical Group Managed Care experience.
• 2 Years Population Health experience.
• Certified Case Manager (CCM) - Commission for Case Manager Certification -PREFERRED

Other Qualification Requirements

• CCM certification is required within 1 year of hire. The department will track and maintain this requirement.

Essential Functions

• Quality of Service
  Responsible for achieving and maintaining high quality of service in an efficient and cost-effective manner.
  Identifies, monitors, and analyzes quality indicators to assure program excellence.
  Evaluates programs for efficiency, safety and effectiveness of standards and protocols.
  Formulates and implements a plan based on population assessment and quality improvement findings in collaboration with the health care team using problem solving and research techniques.
  Supports regulatory, accreditation, and contract required audit processes; provides evidence of adherence to standards and quality outcomes. Assures awareness of local, state, and national standards that affect program and services.
  Identifies and directly confronts issues which affect quality of service; collaborates with management/providers to resolve these issues.
  Identifies opportunities for development and integration of new programs or services to meet defined needs, regulatory requirements, or market driven requirements. Maintains DMHC, CMS and NCQA compliance through internal audits and reporting. Develops action plans to correct identified deficiencies and to ensure ongoing compliance to maintain a state of audit readiness. Prepares for and represents the department for all plan DMHC, CMS and NCQA audits. Provides expertise and guidance with all delegated oversight activities.
• Program Coordination
  Develops/manages the annual work and strategic plans that integrates with the organizational goals within Sharp Health Plan. Identifies ideas and insights into clinical improvements to generate new business or service opportunities. Develop and implement policies and procedures that have direct impact for the day-to-day operations.
  Participates in the development of Sharp Health Plan clinical care and the continuum of care, ensuring the incorporation of quality outcome indicators. Analyzes relevant data to appropriately implement and evaluate program objectives, design, and strategies.
  Incorporates knowledge of external factors and healthcare policies which affect outcomes and measures. Maintains ongoing analysis of program performance and monitors trends and opportunities. Initiates and recommends service improvements to meet changing market needs.
  Establishes and maintains a communication system with staff, providers, individuals, and agencies related to program in an effort to proactively address issues. Prepares accurate and timely written reports, statistics, and other documentation as necessary or as required.
• Leadership and Communication
  Develops collaborative relationships with other departments/entities/healthcare committees and agencies to facilitate and support quality services at Sharp. Provides consultation related to program specialty. Ensures new case and disease management personnel receive appropriate orientation to function independently within the department.
  Uses communication strategies with individual/groups that result in the achievement of intended outcomes between the appropriate committee, physicians or administration.
  Ensures interdisciplinary team work through utilization of principles reflective of high performing teams.
  Serves as a liaison with community agencies, vendors, and other healthcare team members.
  Serves as internal resource and content expert in case management, disease management and population health including quality improvement initiatives.
• Performance/Financial
  Prepares and submits appropriate budget and cost benefit analysis that reflect annual review of programs and program resources. Identifies and implements cost efficient strategies within services and program. Makes recommendation and coordinates interventions with internal and external leadership and staff. Manages, coordinates, and evaluates the implementation of new and existing programs to include budget considerations and constraints. Maintain and develop consistent management reports and dashboards to measure and promote departmental efficiency and effectiveness, which may include delegated PMG’s. Promotes an 'outcomes-based' strategy for care management within the Department
• Human Resources Management
  Ensures the safe delivery of quality patient education and programs according to defined educational and evidenced based standards.
  Assures development and review of position descriptions annually. Effectively role-models leadership in the areas of trust/respect, resolving problems, teamwork/cooperation, and delegation.
  Counsels and evaluates staff members on their performance.
  Assures that staff communication meetings are held at regular intervals. Disseminates information in a timely manner to areas of responsibility. Serves as a mediator for personnel problems which cannot be resolved at a lower level in the organization.
  Interviews and makes decisions for hiring, disciplining, and terminating personnel based on specific technical and psychosocial competencies required in the area. Secures appropriate approvals as necessary.
  Assures that staff have development plans and that the appropriate resources and support are allocated to ensure their completion.
  Facilitates proper flow of personnel action by promptness in completing necessary paperwork.
  Ensures that personnel files support any actions required.
  Develops and implements staff quality improvement trainings.

Knowledge, Skills, and Abilities

• Effective Interpersonal Skills: oral, written and presentation.
• The employee will follow all Safety policies and procedures.

Sharp HealthCare is an equal opportunity/affirmative action employer. All qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, gender, gender identity, sexual orientation, age, status as a protected veteran, among other things, or status as a qualified individual with disability or any other protected class