Tailored Care Management Lead
hace 10 días
Raleigh
DataStaff, Inc. is currently seeking a Tailored Care Management Lead for a contract opportunity with one of our direct clients in Raleigh, NC. \n \n Job Description: \n The Program Manager, TCM Program Lead - Population Health will: \n\n • Support TCM policy updates and the communication plan for notifying stakeholders of policy changes for Provider Certification, TCM program updates and changes.\n, • Support provider education with certification, recertification as well as adding and removing population segments.\n, • Support the development and monitoring of Care Management monitoring protocols.\n, • Support the development of the TCM and AMH Health Home SPAs\n, • Contribute to the design of policy that supports members’ choice of Tailored Care Manager provider.\n, • Lead stakeholder education efforts to support High Needs Members.\n, • Lead stakeholder education efforts to support advisory groups and community stakeholders.\n\n \n Skills: \n\n • Demonstrated experience in population health models, care delivery/care management models, clinical program innovations,\n, • Broad knowledge of health insurance, operations, programs, and policy and procedure.\n, • Understanding of system design and implementation of program requirements and business processes.\n, • Ability to interpret complex data/datasets and other information and communicate trends and probable outcomes.\n, • Experience researching and implementing federal and/or state laws and regulations.\n, • Excellent critical thinking, problem-solving, and project management skills.\n, • Demonstrated ability to communicate complex material in a clear and concise manner both verbally and in writing.\n, • Demonstrated skills in establishing and maintaining strong collaborative working relationships with internal and external stakeholders.\n, • Strong proficiency in Microsoft Office products including Excel, Outlook, PowerPoint, and Word.\n, • Demonstrated ability to multitask with little supervision and flexibility to adapt to shifting priorities and short-term deadlines.\n\n \n Expectations in the form of Goals and Tasks: \n\n • Lead TCM Provider Certification Program.\n, • Lead Program Policy document Updates (example: TCM Provider Manual).\n, • Create TCM Provider Surveys to understand areas for TCM Program improvement/education.\n, • Support TCM Provider education efforts to drive positive member outcomes.\n, • Lead efforts to identify and mitigate TCM Provider Administrative burden.\n, • Lead process to resolve CMA/AMH+ Administrative Site issues, preserving member TCM assignment.\n\n \n This opportunity is available as a W2 position with a competitive benefits package. DataStaff, Inc. offers medical, dental, and vision coverage options as well as paid vacation, sick, and holiday leave. As many of our opportunities are long-term, we also have a 401k program available for employees after 6 months.