What are the responsibilities and job description for the Manager, Population Health (PH) & Concierge Care Coordination (C3) position at SOUTH FLORIDA COMMUNITY CARE NETWORK LLC?
Job Details
Description
Maternal Child Health
Position Summary:
The Manager of Population Health and Concierge Care Coordination is responsible for providing leadership, supervision, and strategic oversight of the Population Health and Concierge Care Coordination (C3) programs at Community Care Plan (CCP).
The Manager of Population Health and Concierge Care Coordination (C3) is responsible for the management and oversight of the Population Health & Concierge Care Coordination team, which includes Registered Nurses (RNs), Social Workers, and Healthcare Navigators.
This role focuses on managing the care coordination needs for diverse populations, including but not limited to Adults, Pediatrics, Medically Enhanced, and Medical Foster Care enrollees, Maternity, Behavioral Health, Serious Mental Illness, while integrating social work practices to address the holistic needs of members.
The Manager of PH & C3 coordinates and facilitates the ongoing development of the Population Health & Concierge Care Coordination program, including updating policies, creating new processes, and ensuring that program updates and clinical guidelines are reviewed at least biannually. Additionally, this role promotes interdepartmental collaboration to enhance care coordination, trains new staff, gathers and analyzes outcome reports, and supports the overall success of CCP’s Population Health & Care Coordination initiatives.
The Manager will work to ensure that care coordination services are delivered in accordance with regulatory guidelines, clinical standards, and organizational goals. Additionally, the role requires fostering collaboration across departments to ensure high-quality, evidence-based care for enrollees, with the goal of improving health outcomes, optimizing care delivery, and enhancing the member experience.
Job functions are performed in accordance with requirements of the Medicaid contract, Florida Healthy Kids (FHK) Contract, South Broward Community Health Services (SBCHS) contract, Community Care Plan (CCP) policies and procedures, and Patient Centered Medical Home (PCMH) standards.
Essential Duties and Responsibilities:
Program Management and Oversight
- Provide comprehensive management and oversight of the Population Health & Concierge Care Coordination team, including RNs, Social Workers, and Healthcare Navigators, ensuring smooth daily operations within the department.
- Lead the ongoing development and evolution of the Concierge Care Coordination (C3) program, ensuring compliance with AHCA, AAAHC, NCQA, and other contractual or accreditation requirements.
- Conduct biannual reviews of clinical guidelines and program policies, updating them as needed to reflect current standards of practice.
- Create new policies and procedures as identified to address gaps and ensure that the program remains compliant with all contractual and accreditation standards.
- Serve as a key resource for Chronic Disease and Care Coordination issues, providing necessary tools and support to the team to ensure successful care coordination.
Team Leadership and Training
- Train and orient new Population Health & Concierge Care Coordination staff on all aspects of the program, ensuring that team members are proficient in their roles and knowledgeable about software system enhancements.
- Monitor team members' performance, ensuring they meet minimum standards for medical-psycho-social assessments, care planning, and evaluation.
- Ensure that goals set in care plans are Specific, Measurable, Achievable, Realistic, and Time-bound (SMART) and address the identified needs of enrollees, ultimately improving member quality of life.
- Conduct regular staff meetings to communicate program changes, contractual and accreditation updates, and to address any staff needs.
- Perform annual staff performance evaluations and provide ongoing coaching and development opportunities.
Compliance and Accreditation
- Ensure that Population Health & Concierge Care Coordination policies and procedures are reviewed annually, modified as needed, and compliant with all contractual obligations.
- Ensure that the team maintains compliance with accreditation standards related to care coordination programs.
- Oversee adherence to HIPAA guidelines and ensure that staff maintain patient confidentiality at all times.
Collaboration and Program Development
- Promote interdepartmental collaboration across all CCP departments to ensure enrollees receive evidence-based care and recommended preventive screenings.
- Actively participate in the development of new clinical management programs and protocols as identified needs arise.
- Assist with the creation of educational materials and tools for the deployment of Chronic Disease and Care Coordination programs to enhance care coordination efforts.
Quality Monitoring and Improvement
- Monitor staff documentation to ensure it meets standards for thoroughness, care planning, and alignment with clinical guidelines.
- Regularly review and analyze outcome reporting to assess the effectiveness of the care coordination program and identify areas for improvement.
- Facilitate partnerships for 7-day follow-up reviews and assist in ensuring enrollee benefits are properly managed and documented.
- Track and ensure compliance with key program components, including medication list updates, PASRR tracking, Medicaid redeterminations, and level of care (LOC) redeterminations.
Administrative Oversight
- Manage the team’s time and attendance, ensuring that direct reports adhere to department schedules and productivity requirements.
- Oversee call queue management and ensure that enrollee queries are handled efficiently by the care coordination team.
- Facilitate technology implementation for department fax retrieval and distribution, as well as the processing of enrollee signature forms.
- Support Grievance and Appeals processes on behalf of enrollees, ensuring timely responses and resolutions.
Continuous Learning and Adaptability
- Stay informed of industry changes and trends to ensure that the Population Health & Concierge Care Coordination program remains innovative and compliant with regulatory guidelines.
- Foster an environment of continuous learning, providing staff with professional development opportunities and encouraging adaptability to meet evolving departmental needs.
- Oversee compliance with disaster outreach efforts, such as hurricane preparedness, to support vulnerable enrollees during times of crisis.
This job description in no way states or implies that these are the only duties performed by the employee occupying this position. Employees will be required to perform any other job-related duties assigned by their supervisor or management.
Skills and Abilities:
Knowledge:
- Strong knowledge of Medicaid, care coordination processes, and healthcare regulatory requirements.
- Knowledge of population health strategies and best practices for integrating social determinants of health into care coordination efforts.
Leadership:
- Demonstrated leadership skills with experience in team management and program oversight.
Technical:
- Proficiency in healthcare software systems and electronic medical records (EMR).
Self-Motivation and Independence:
- Demonstrates the ability to self-motivate and work independently, managing time and resources effectively to complete tasks with minimal supervision.
Communication:
- Excellent communication, interpersonal, and organizational skills with the ability to manage multiple priorities.
- Exceptional oral and written communication skills, with the ability to clearly convey complex information to diverse audiences, including patients, healthcare providers, and team members.
- Strong interpersonal communication skills, with the ability to effectively collaborate and build relationships within multidisciplinary teams.
Organizational and Problem-Solving Skills:
- Highly organized with excellent problem-solving abilities, capable of managing multiple priorities and tasks in a dynamic healthcare environment.
- Skilled in professional interaction and human relations, with the ability to navigate complex patient and provider interactions.
Team Collaboration:
- Proficient in processes to build and participate in cross-functional teams, promoting a collaborative approach to care coordination and complex case management.
Project Management:
- Ability to follow through on projects or assignments to successful completion, demonstrating decisive judgment and a commitment to quality outcomes.
Motivational Interviewing and Education:
- Experience with motivational interviewing techniques and understanding of adult learning styles to engage and educate members in self-management of their conditions.
Analytical Skills:
- Strong analytical skills with the ability to read and interpret various documents, including safety rules, operating and maintenance instructions, and procedure manuals.
- Ability to write routine reports and correspondence and to present information effectively before groups of customers or employees.
Mathematical Skills:
- Competent in basic mathematical skills, including the ability to add, subtract, multiply, and divide in all units of measure. Capable of computing rates, ratios, and percentages, and interpreting bar graphs.
Practical Problem-Solving:
- Ability to solve practical problems and address a variety of concrete variables in situations where only limited standardization exists. Able to interpret various instructions furnished in written, oral, diagram, or schedule form.
Physical Demands:
The physical demands outlined below are representative of those required for an employee to successfully perform the essential functions of this role. Reasonable accommodations may be made to enable individuals with disabilities to fulfill these essential functions.
- Regular Activities: While performing the duties of this job, the employee is regularly required to sit for extended periods, use hands to handle or feel objects, tools, or controls, reach with hands and arms, and communicate verbally to effectively interact with team members and enrollees.
- Frequent Activities: The employee is frequently required to stand, walk, and sit, which may involve moving between different areas of the work environment.
- Occasional Activities: The employee may occasionally be required to stoop, kneel, crouch, or crawl to perform specific tasks or to access certain areas.
- Lifting Requirements: The employee may occasionally need to lift and/or move items weighing up to 15 pounds.
Work Environment:
The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of the job. The environment includes work inside/outside the office, travel to other offices, as well as domestic, travel. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. The noise level in the work environment is usually moderate.
We are an equal opportunity employer who recruits, employs, trains, compensates and promotes regardless of age, color, disability, ethnicity, family or marital status, gender identity or expression, language, national origin, physical and mental ability, political affiliation, race, religion, sexual orientation, socio-economic status, veteran status, and other characteristics that make our employees unique. We are committed to fostering, cultivating, and preserving a culture of diversity, equity, and inclusion.
Work Schedule:
As a continued effort to provide a safe and productive work environment, Community Care Plan is currently following a hybrid work schedule. Staff are able to work from home 3 days a week and will report to the office 2 days a week. *****The company reserves the right to change the work schedules based on the company needs.
Qualifications
- Maternal Child Health
- Bachelor’s degree or higher in Nursing.
- Master’s degree preferred.
Certificates and Licenses:
- Registered Nurse licensure in the state of Florida (Required)
- Psychiatric/Mental Health Nursing Certification (Preferred for BH/SMI Management)
- Certified Case Manager (Preferred)
- Certified Addictions Registered Nurse (CARN) (Preferred for BH/SMI Management)
Experience:
Clinical Experience:
- 7-10 years of clinical experience in managing chronic diseases, complex medical cases, behavioral health, or care coordination, preferably in settings such as hospitals, outpatient clinics, or community health organizations.
Experience in Managed Care/Health Plan Setting:
- 3-5 years of supervisory experience working in a managed care, health plan, or insurance environment, specifically in roles related to population health, behavioral health management, chronic disease management, case management, Maternity Management, or care coordination.
Care Coordination and Case Management:
- Demonstrated experience supervising the coordination of care for members with complex medical needs, including conducting needs assessments, developing care plans, and collaborating with multidisciplinary teams to close gaps in care and improve health outcomes.
Utilization Management:
- Knowledge/Experience with utilization management processes, including prior authorizations, appeals, and reviewing clinical documentation to ensure appropriate use of healthcare resources.
Regulatory Knowledge:
- Familiarity with Medicaid, Medicare, or other state and federal healthcare programs, including knowledge of relevant regulations, compliance standards, and quality benchmarks.
Technical Proficiency:
- Proficient in Microsoft Office Suite and other relevant software for documentation and data management.
- Experience with electronic health records (EHR) systems such as EPIC, JIVA, or similar platforms is preferred.
