Cook County, IL Chicago , IL 60602
Posted 2 weeks ago
Job Title Department
Manager of Transitional Care Health Plan Services
This position is exempt from Career Service under the CCH Personnel Rules.
Job Summary
The Manager of Transitional Care serves as a key member of the clinical services team, supporting utilization management and integrating across all health plan clinical team. Using evidenced based practices, is responsible for developing programs, goals, and processes to support members experiencing transitions levels of care, care providers/settings or program eligibility. Oversees the Transition of Care (TOC) models utilized by Health Plan Services partners to ensure a cohesive approach and appropriate support and continuity for all members' physical and behavioral health services, achieve members' health goals, and improve cost-effective health outcomes. Works independently and as a collaborative member of the Health Plan Services administrative team and with all levels of Cook County Health (CCH), partners and providers.
General Administrative Responsibilities
Collective Bargaining
Review applicable Collective Bargaining Agreements and consult with Labor Relations to generate management proposals
Participate in collective bargaining negotiations, caucus discussions and working meetings
Discipline
Document, recommend and effectuate discipline at all levels
Work closely with labor relations and/or labor counsel to effectuate and enforce applicable Collective Bargaining Agreements
Initiate, authorize, and complete disciplinary action pursuant to CCH system rules, policies, procedures and provision of applicable collective bargaining agreements
Supervision
Direct and effectuate CCH management policies and practices
Access and proficiently navigate CCH records system to obtain and review information necessary to execute provisions of applicable collective bargaining agreements
Management
Contribute to the management of CCH staff and CCH' systemic development and success
Discuss and develop CCH system policy and procedure
Consistently use independent judgment to identify operational staffing issues and needs and perform the following functions as necessary; hire, transfer, suspend, layoff, recall, promote, discharge, assign, direct or discipline employees pursuant to applicable Collective Bargaining Agreements
Work with Labor Relations to discern past practice when necessary
Typical Duties
Develops program description work plans and annual program goals for transitions of care, for approval by leadership and oversight committees
Ensures that plans and program goals reflect the needs of the membership and a clear model for promoting cost-efficiency and quality of care goals and strategic directions of health plan and CCH, including National Committee for Quality Assurance (NCQA) health plan accreditation
Analyzes data and conducts monthly/quarterly/annual evaluation of work plan to identify program successes as well as barriers/impediments to achieving performance benchmarks.
Recognizes trends, identifies opportunities, and assess financial impact to design and lead improvement initiatives
Utilizes data and experiences of members, provider, and partners to make recommendations to leadership regarding network providers
Develops relationships with transition stake holders, e.g., large volume hospitals, CCH staff, ACHN leadership, community organizations
Prepares reports for various audiences, makes, and implements recommendations for improvement
Develops, organizes, and manages workflows, processes, and job aids to support the provision of transition related activities and assesses ability to promote desired outcomes as well as comply with regulatory requirements and vendor agreements
Researches, develops, and implements TOC interventions that will increase use of health care, improve health, and promote cost-effectiveness of health care utilization
Collaborates and coordinates people and systems to leverage health plan and CCH resources.
Foster strong relationships with diverse stakeholders from all community sectors
Engages and works collaboratively with contracted/delegated care management entities and medical management staff, vendors, behavioral and physical health providers, and social services to assure integration of direct health care services
Provides oversight of vendors including facilitation of vendor meetings, monitoring of key performance indicators and collateral outcomes
Provide and facilitates training for Health Plan Services staff and network partners
Support health plan accreditation standards, regulatory compliance and effective participation in broader care delivery systems and mandates
Participates in the development of information technology systems for optimal information sharing across entities and care settings
Facilitates and promotes timely problem identification, analysis, and resolution
Travels to work sites throughout Cook County including Federally Qualified Health Centers, hospitals, regulatory and State agency offices
Performs other duties as assigned
Minimum Qualifications
Bachelor's degree from an accredited college or university is required (Must provide official transcript at the time of interview)
Licensed as a Registered Nurse, Licensed Clinical Social Worker (LCSW) or Licensed Clinical Professional Counselor (LCPC) in the State of Illinois or have the ability to obtain Illinois license prior to starting employment is required
Two (2) years of work experience in a health care setting such as home care, physician's office/ambulatory care, acute care is required
Two (2) years of supervisory or management work experience is required
One (1) year of care coordination work experience is required
One (1) year of work experience pertaining to transition related activities is required
Preferred Qualifications
One (1) year working on transition related activities within a community-based, hospital-based or health plan setting
One (1) year of experience working with Medicaid and/or Medicare population
Knowledge, Skills, Abilities and Other Characteristics
Knowledge of quality improvement approaches
Knowledge of electronic medical records or care management systems
Knowledge with identifying data needs and supporting report development
Knowledge of managed care
Excellent verbal and written communication skills necessary to communicate with all levels of staff and a patient population composed of diverse cultures and age groups
Strong analytical and problem-solving skills
Ability to develop workflows to support transition activities
Ability to engage internal and external stakeholders to support transition activities
Ability to adhere to department policies and standards utilizing best practices incorporating the use of electronic health record (EHR)
Ability to meet appropriate confidentiality standards for protected health information (PHI)
Physical and Environmental Demands
This position is functioning within a healthcare environment. The incumbent is responsible for adherence to all hospital and department specific safety requirements. This includes but is not limited to the following policies and procedures: complying with Personal Protective Equipment requirements, hand washing and sanitizing practices, complying with department specific engineering and work practice controls and any other work area safety precautions as specified by hospital wide policy and departmental procedures.
The above statements are intended to describe the general nature and level of work being performed by people assigned to this classification. They are not intended to be construed as an exhaustive list of all responsibilities, duties and skills required of the personnel so classified.
For purposes of the American with Disabilities Act, "Typical Duties" are essential job functions.
VETERAN PREFERENCE
PLEASE READ
When applying for employment with the Cook County Health & Hospitals System, preference is given to honorably discharged Veterans who have served in the Armed Forces of the United States for not less than 6 months of continuous service
To take advantage of this preference a Veteran must:
Meet the minimum qualifications for the position.
Identify self as a Veteran on the employment application by answering yes to the question by answering yes to the question, "Are you a Military Veteran?"
Attach a copy of their DD 214, DD 215 or NGB 22 (Notice of Separation at time of application filing. Please note: If you have multiple DD214s, 215s, or NGB 22S, Please submit the one with the latest date. Coast Guard must submit a certified copy of the military separation from either the Department of Transportation (Before 9/11) or the Department of Homeland Security (After 9/11). Discharge papers must list and Honorable Discharge Status. Discharge papers not listing an Honorable Discharge Status are not acceptable.
OR
A copy of a valid State ID Card or Driver's License which identifies the holder of the ID as a Veteran, may also be attached to the application at time of filing.
If items are not attached, you will not be eligible for Veteran Preference
VETERANS MUST PROVIDE ORIGINAL APPLICABLE DISCHARGE PAPERS OR APPLICABLE STATE ID CARD OR DRIVER'S LICENSE AT TIME OF INTERVIEW.
MUST MEET ALL REQUIRED QUALIFICATIONS AT TIME OF APPLICATION FILING.
BENEFITS PACKAGE
Medical, Dental, and Vision Coverage
Basic Term Life Insurance
Pension Plan
Deferred Compensation Program
Paid Holidays, Vacation, and Sick Time
You may also qualify for the Public Service Loan Forgiveness Program (PSLF)
100% Tuition Reimbursement for nursing-related programs
For further information on our excellent benefits package, please click on the following link: http://www.cookcountyrisk.com/
Degrees awarded outside of the United States with the exception of those awarded in one of the United States' territories and Canada must be credentialed by an approved U.S. credential evaluation service belonging to the National Association of Credential Evaluation Services (NACES) or the Association of International Credential Evaluators (AICE). Original credentialing documents must be presented at time of interview.
COOK COUNTY HEALTH AND HOSPITALS SYSTEM IS AN EQUAL OPPORTUNITY EMPLOYER
Cook County, IL