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Care Manager-Quality Initiatives

Company: MyMichigan Health
Location: Midland
Posted on: August 4, 2022

Job Description:

Summary As an integral role within the ambulatory quality care team, the Care Manger of Quality Initiatives ensures coordination of care for health prevention and chronic disease management specific to payor sponsored programs. This position works collaboratively with ambulatory care team members and various departments within Health to achieve desired payor program objectives while providing high quality and cost-effective care This position integrates evidence-based clinical guidelines, preventive guidelines, and protocols, in the development of individualized care plans that are patient-centric, in order to promote quality and efficiency in the delivery of health care. This position will assist with educating, tracking and monitoring the status of specific payor value-based program requirements and will provide direct patient care. This position reports to the Manager of Ambulatory Care Management, with significant collaboration between MyMichigan Medical Group (MMG) and Collaborative Care Organization. (MCCO). ESSENTIAL RESPONSIBILITIES

  • COORDINATION AND COLLABORATION ACROSS THE CONTINUUM Utilizes effective teaching methods and approaches Collaborates with Primary Care Providers (PCP), patients, and members of the health care team to identify patients for intervention Responsible for developing a comprehensive individualized plan of care and targeted interventions for defined patients Continually monitors patient/family response to plan of care and revises as indicated Implements clinical interventions and protocols based on program guidelines and evidence based clinical guidelines Educates patient on care plan pathway and expectations based on program guidelines
  • ENSURING KEY PROGRAM PERFORMANCE INDICATORS ARE MET Participates in all education sessions provided by payor coordinating centers Educates participating providers and appropriate staff Collaborates with the care manager, pharmacist, provider and other key members of the care team to determine key barriers or obstacles for appropriate care and facilitates the establishment of a care plan. Ensures that insurance benefit information is obtained and utilized in advance in formulating plan Documents key data elements per protocol Communicates with providers and support staff to set expectations and educate regarding care plan
  • CUSTOMER SERVICE, TEAMWORK AND COMMUNICATION SKILLS Promotes self in a positive and professional manner Maintains patient and staff confidentiality Utilizes effective written and verbal communication methods Establishes effective working relationships with providers, care team, and patients as appropriate PERFORMANCE AND PROCESS IMPROVEMENT Responsible for ensuring program performance metrics are met Develops and implements process improvements in collaboration with key stakeholders Seeks process improvements consistent with organizational priorities and goals Obtains program targeted data Collects and tracks performance improvement data Assists with clinical effectiveness studies and projects Other duties as assigned to support program development OTHER DUTIES AND RESPONSIBILITIES
    • Effective time management and organizational skills Fosters a team approach and includes patient/family as active members of the team
    • Facilitates and supports the implementation of strategic value-based quality program initiatives.
    • Maintains accurate and timely documentation for clinical and program initiatives
    • Works with MPG and MCCO leadership to continuously evaluate processes, identify problems, and propose/develop new strategies to enhance care management and/or value-based program adherence. Ability to operate a PC and Microsoft Office software application is required Experience with use of Epic Electronic Health Record is preferred REQUIRED CERTIFICATION AND LICENSURE BLS - Basic Life Support Required Equivalent Experience - Basic life supprt within 1 months of hire or transfer date. CDE - Cert Diabetes Educator Preferred Equivalent Experience - Registered Dietitian with certificaiton in diabetes education is preferred. RN - Registered Nurse REQUIRED EDUCATION Bachelor's Degree Comments: Experience in complex care management and/or diabetes education is preferred. EXPERIENCE, TRAINING AND SKILLS
      • Care Management or Certified Diabetes Educator experience
      • Patient care experience in chronic disease management and patient teaching
      • Knowledge of chronic conditions, evidence-based guidelines, prevention, wellness, and health risk assessment
      • Experience with provider and patient education, creating a plan of care, and self-management support Ability to implement evidence-based interventions and protocols for chronic conditions
      • Critical thinking and problem-solving skills and ability to analyze complex data and make recommendations for improvement
      • Excellent written and verbal communication skills, ability to communicate successfully with individuals, groups, and health care professions Experience working with and educating diverse groups, both large and small, including patients, community members, and healthcare providers

Keywords: MyMichigan Health, Midland , Care Manager-Quality Initiatives, Executive , Midland, Michigan

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