Manager, Comprehensive Care Advocacy

HealthPartners is hiring a Manager, Comprehensive Care Advocacy. This position exists to:

• Develop and manage successful, innovative, and member-centered Case/Disease Management programs; to assure strategic alignment of program activity; and to achieve annual goals and objectives.
• Provide innovative, dynamic, and service oriented leadership for supervisors and staff in the Case/Disease Management programs.
• Cct as a clinical, program, and fiscal consultant for all members of the team regarding complex issues as they relate to Case/Disease Management.

ACCOUNTABILITIES: 

1. Responsible for the supervision of staff, including having the authority to hire, transfer, lay off, promote, discipline and discharge, train, reward and review performance of employees. Ensures compliance to organizational and departmental policies and procedures.
2. Leadership
   1. Represents the case/disease management programs across the organization to ensure that the services are coordinated with strategic initiatives across the enterprise.
   2. Builds effective relationships, inspires others to achieve excellence, embraces change, and creates the willingness to change in others.
   3. Consistently applies the corporate values of HealthPartners in relationships, daily work, and program management.
   4. Designs practices, processes, and procedures which allow managing from a distance.
   5. Ensures that all staff receive regular performance feedback and a timely performance evaluation; collaborates with Senior Leadership regarding staff budget and compensation.
   6. Executes new strategic initiatives
3. Program Management and Evaluation
   1. In collaboration with the Senior Leadership, develops program goals; utilizes the Triple Aim methodology to identify and prioritize drivers and strategies for each program.
   2. Develops and leads successful, timely strategies to meet annual program goals for Experience, Health, and Affordability.
   3. Identifies appropriate measures which will be used to monitor progress on these goals.
   4. Assumes responsibility for routine, timely measurement of program metrics and analyzes to identify trends and opportunities to improve.
   5. Process Management:
      1. Supports supervisor(s) in daily operations.
      2. Develops and monitors key metrics to monitor performance of key processes.
   6. Prioritizes and initiates improvement efforts as necessary and when appropriate.
4. Clinical Design
   1. Designs and executes new, innovative programs with cross-functional and strategic partners, both internal and external
5. Member Focus
   1. Ensures all staff and program functions are member focused, resulting in high levels of member and family satisfaction.
6. Relationships and Team Building
   1. Creates and maintains high performing team(s); facilitates effective cross-functional teamwork within the department and with other departments to collaborate in patient care and performance improvement activities.
7. Quality Assurance and Compliance
   1. Develops and maintains policies and procedures to support program(s) and to ensure adherence to contractual requirements, as well as regulatory and accreditation standards. 
   2. Ensures timely completion of reports for health plan, regulatory, accreditation, reinsurance, and any other requirements.
   3. Works with Government Programs to ensure compliance with Medicare and Medicaid requirements and regulations.
8. Integration
   1. Effectively integrates the Case/Disease Management program with other medical management programs within the health plan, HealthPartners Medical Group, contracted medical groups, and other strategic partners.
9. Communication
   1. Effectively communicates with staff, physicians, members, management, customers, and others to facilitate the flow of information necessary for success of patients and families, employees, department, and the organization.
   2. Collaborates with senior leadership and program supervisors to establish and maintain routine reporting processes, both oral and written, to ensure ongoing and complete communication of program status, outcomes, changes, and ongoing activity to those within and outside of the department.
   3. Maintains appropriate confidentiality of information in accordance with HealthPartners corporate policies.
10. Technology
    1. Ensures maximum program productivity through proficient use of technology including computers, phones, Rightfax, IP agent, cell phones, and pagers as appropriate.
11. Personal Development
    1. Participates in ongoing independent study, education related professional activities, and professional affiliations to maintain knowledge in the areas of case/disease management, patient care services, and how to create standards of excellence in a growing and changing field of practice.
    2. Demonstrates effective project management skills, including use of project planning and tracking tools; development of achievable goals, objectives, and timelines; innovative use of resources, and attention to financial analysis.
    3. Demonstrates responsiveness to and appreciation of constructive feedback and recommendations for personal growth and development.
12. Other duties
    1. Actively participates in the creation, update, and ongoing testing of business continuity and disaster recovery planning and preparation.
    2. Willingly participates in and/or effectively leads various committees, task forces, projects and quality improvement initiatives as needed and assigned.
    3. Other duties as assigned.

REQUIRED QUALIFICATIONS: 

• Professional college degree in healthcare field.
• Relevant certification coursework within 24 months of employment. 
• Minimum of 5 years clinical practice experience; minimum of 5 years relevant case/disease management experience and current clinical knowledge.
• Five years of demonstrated effective, independent leadership and management skills as well as experience in the development of new and ongoing medical management programs that have resulted in measurable improvement of experience, health, and stewardship outcomes.
• Demonstrated skill and experience in effectively relating to and collaboratively working with physicians, medical administrators, and team members using a high level of expertise in written, oral, and interpersonal communications.
• Demonstrated skill and experience in designing and executing new programs and strategies
• Demonstrated working knowledge of QI, UM, benefit plans fiscal management, and various payment methodologies. Understanding of healthcare and/or HMO industry.
• Demonstrated ability to identify and negotiate boundaries of accountability and authority within multiple disciplines and departments.
• Demonstrated expertise in clinical, financial, and statistical data analysis and reporting.
• Demonstrated skill in effective use and management of automated medical management systems.
• Demonstrated flexibility, organization, and appropriate decision-making under challenging situations.

PREFERRED QUALIFICATIONS:

• Registered Nurse with current license in the State of Minnesota, or equivalent; BSN preferred.

DECISION-MAKING: 

Makes independent decisions within the scope of this position’s accountabilities and determines the need for and the timing of consultation with senior leadership and/or medical director. 

• Common areas of focus:
• Program-specific processes
• Program-specific Policies and Procedures
• Program design
• Strategic initiative execution