RN Supervisor, Telephonic Disease Management / 3413 Job in Mechanicsburg 17050, Pennsylvania US

Position Description

RN Supervisor, Telephonic Disease Management / 3413

Position Description:

APS Healthcare provides health services to our member populations, with the goal of improving the health of those we serve. We have an exciting opportunity for a RN Supervisor, Telephonic Disease Management based in our Mechanicsburg, PA office.

The ACCESS Plus Program is a primary care case management (PCCM) system that features a “medical home” – a designated Primary Care Provider (PCP) – for each ACCESS Plus Enrollee in the 42 county ACCESS Plus area. ACCESS Plus is an enhanced PCCM program, delivering greater value to Enrollees, Providers, and the DPW. These enhancements are designed to improve access to appropriate primary, specialty, dental, and behavioral healthcare for the program Enrollees.

Summary:
The RN Supervisor, Telephonic Disease Management is responsible for ensuring the professional delivery of care management programming through the oversight, leadership and management of the telephonic team including telephonic health coaches and other APS personnel, as appropriate.

The RN Supervisor, Telephonic Disease Management supports the Manager and Director in executing the overall vision, mission, and goals for the organization and specific state/contract requirements. This individual additionally focuses on the development and implementation of key workflows, policies, and related projects/activities from a clinical, financial, satisfaction and quality standpoint to support the daily operation and delivery of health services.

The RN Supervisor, Telephonic Disease Management recruits, trains, evaluates and delegates work to the appropriate staff level and ensures delivery of care and service in alignment with federal and state regulatory requirements and scope of practice for clinical position. The RN Telephonic Supervisor collaborates and interacts closely with the corporate and state/contract specific management teams in addition to the operational teams.

Essential Functions:
• FINANCIAL: Assists Manager and Director in ensuring achievement of contractual financial obligations, including budgetary development and adherence, financial performance guarantees and cost savings.
• OPERATIONAL: Ensures the responsible and professional delivery of comprehensive service and care delivery of the medical management programs, e.g. case and disease management, with a focus on telephonic level activity, including the facilitation of relationships with community resources and appropriate assignments for telephonic staff. Provides daily operational oversight to telephonic DM team, including appropriate referral and caseload assignments in alignment with employee experience and capabilities. Continuously evaluates, reports and implements improvements to impact staff productivity and quality of performance through available telephony and medical management applications and supportive data. Supervises and problem-solves with staff on clinical and contract-specific issues. Works with the training department and identified key staff to ensure that the clinical staff members are trained in areas for which they are hired and that adequate staffing levels are maintained. Develops strong working relationships with contracting agency, as well as, providers and community organizations. Performs performance management reviews and HR oversight of assigned personnel.
• CORPORATE CULTURE: Promotes mission, vision and values of APS Healthcare. Demonstrates ownership of position and proactively carries out position duties with limited direction and/or oversight. Maintains professional licensure(s), certification(s), and completes required continuing education credits to support ongoing position requirements. Promotes and facilitates positive team atmosphere by demonstrating the ability to work within a team and support team efforts. Completes administrative activities consistently and in alignment with corporate policies and procedures.
• QUALITY/SATISFACTION: Supervises the quality management programmatic activities that are the direct responsibility of the Health Services telephonic team. Assists in the achievement and ongoing maintenance of URAC and NCQA accreditations for defined programs. Demonstrates and facilitates customer service excellence. Monitors activity of telephonic team through monitoring efforts (ex/ IRR, case review, case audits, call monitoring, etc.).

Education:
• Registered Nurse with valid, unrestricted license in PA.
• Bachelors Degree in a health related field required.
• Certification in chronic care professional (CCP), case management (CCM), or other clinically-relevant discipline preferred.

Qualifications:
• Minimum 4-6 years demonstrated in a medical management discipline or disciplines, e.g. disease management, case management, population management, etc.
• Minimum 3-4 years call center management experience.
• Knowledge and familiarity with public sector health coverage payment systems, e.g. Medicare / Medicaid.
• Knowledge of principles, ethics, and precepts of care management service delivery.
• Knowledge of data necessary to inform operational and managerial decision making.
• Knowledge of customer service principles.
• Understanding of adult learning and behavior change principles preferred.
• Knowledge of regulatory and accreditation standards.
• Knowledge of national clinical practice guidelines related to clinical program delivery.
• Strong written and verbal communication skills.
• Strong operational and performance management skills.
• Strong interviewing and hiring skills.
• Strong prioritization and organizational skills
• Solid computer skills, e.g. care management applications, Microsoft Office (Word, Excel, PowerPoint, Access, VISIO).
• Ability to interpret data from call center and care management applications and apply analysis toward operational and performance management and productivity improvements.
• Able to demonstrate critical thinking within daily supervisory activities of care management delivery and performance management.
• Ability to demonstrate effective reasoning to inform leadership efforts within and among a team of clinical and non-clinical professionals
• Ability to forecast risk and demand for services to allow for planning of adequate staff coverage to support delivery on overall accountabilities.