HFHP Supervisor Care Navigation- Member Outpatient Services Position Available In Brevard, Florida

HFHP Supervisor Care Navigation- Member Outpatient Services Health First Careers – 3.6

Melbourne, FL Job Details Full-time Estimated:

$46.4K – $59.5K a year 22 hours ago Benefits Health insurance Qualifications Microsoft Word Microsoft Excel Management Managed care Customer service Quality management Mid-level Analysis skills Database management Organizational skills Computer skills Communication skills Time management Full Job Description Job Requirements

POSITION SUMMARY

This position works collaboratively with Health First Health Plan departments and clinical IDN entities to support the effective, collaborative management of members with complex, chronic conditions across the care continuum. This position provides supervision of staff within the Centralized Care Navigation services. S/he is responsible to develop/revise relevant HFHP policies, workflows, tools and ensure continuous adherence to regulatory requirements for care coordination. In addition to the supervisory function, this position is also responsible to facilitate the development of chronic condition programs, supporting pathways/protocols, and best practices in care coordination and management of select disease states. Program development will encompass strategies for member activation and engagement, criteria for vendor services (when applicable) as well as provider interventions and oversight. This position will evaluate the effectiveness of these interventions for selected member populations and develop processes that enhance improvement in quality of care and coordination for members.

PRIMARY ACCOUNTABILITIES

Engagement:

Promotes associate accountability and competency through leadership and management practice Completes annual performance appraisals and competency checklists for associates Encourages associate growth and development through mentorship and goal setting Actively participates in committees, work groups and leads improvement teams

Quality/No Harm:

Assists with and participates in the development of policies, procedures, workflows, and desktop procedures for the department and HFHP. Ensures compliance with regulatory agencies such as NCQA, QIO, Medicare and AHCA. Conduct annual policy and procedures reviews and oversee revisions as deemed necessary. Assists with implementation of department performance improvement activities resulting in improved operations outcomes Maintains knowledge of regulations/standards as well as relevant clinical practice guidelines and evidence-based benchmarks Optimizes member health by increasing provision of evidence based preventative and chronic care measures Creates and monitors programs intended to improve the quality of care and coordination of services for members with chronic conditions Utilizes evidenced- based guidelines and risk stratification methodologies as the basis for program development Analyzes data from internal and external sources to identify opportunities for improvement in chronic care management Develops cross-continuum care pathways as well as supporting protocols, tools and education for select chronic conditions Ensures clinical integration and collaboration with Health First programs and services as well as community partners and resources Serves as central point of coordination for member outreach events relevant to chronic care management Collaborates with IDN partners to develop strategies for member activation, engagement and self-management Evaluates effectiveness utilizing qualitative and quantitative metrics of success; facilitates program modifications for improvement

Customer Experience:

Consistently displays and holds associates accountable to the highest level of customer experience Serves as a subject-matter expert in the field of chronic care coordination and member engagement/self-management Participates in Health Plan sponsored community events relevant to quality improvement and member engagement Provides analyzed and actionable information on chronic care improvement initiatives to key stakeholders including providers, plan leadership and IDN partners Supports readiness for regulatory agency audits/accreditation surveys applicable to chronic care management and respond to RFPs through preparation of reports and documents

Stewardship :

Assists in the development of the unit’s annual budget, including operating and capital budget planning Establishes criteria for vendor services and determines appropriateness of services within the chronic care pathways; incorporates risk-stratification methodologies and utilization benchmarks to evaluate effectiveness of services Manages relationships with outsourced vendors for chronic care management such as Alere Health, Health First House Calls, etc. as it relates to effectiveness of clinical services provided to members (utilization, customer service, outcomes) Employs LEAN principles to minimize waste such as duplication of clinical services, rework associated with ineffective transitions of care, etc. Work Experience

QUALIFICATIONS REQUIRED

Experience in Managed Care or Community Health setting required Background in Quality Management and/or Population Health preferred Excellent verbal and written communication skills; ability to convey complex or technical information in a manner that others can understand Proficiency in healthcare-related applications, EMR, Word, Excel, and a basic understanding of database management Advanced analytical skills; strengths in data aggregation, analysis and display Knowledge of clinical standards of care, preventive health standards, HEDIS, NCQA, governing and regulatory agency requirements Ability to build strong, positive relationships with medical staff, peers, and internal company staff at all levels Related management experience preferred Sound organizational skills to include time management and problem solving

PHYSICAL DEMANDS

Ability to sit, navigate and view computer applications for several hours at a time while communicating verbally by telephone Work effectively in a fast-paced often stressful environment Ability to communicate effectively with physicians, members, vendors, and other internal Health First Health Plans Associates and external customers

MENTAL DEMANDS

Ability to coordinate multiple projects and demands on an ongoing basis Ability to adapt to changing organizational requirements and business applications Ability to maintain professionalism in the face of adversity Ability to maintain confidentiality in all pertinent matters Benefits

ABOUT HEALTH FIRST

At Health First, diversity and inclusion are essential for our continued growth and evolution. Working together, we strive to build and nurture a culture that recognizes, encourages, and respects the diverse voices of our associates. We know through experience that different ideas, perspectives, and backgrounds create a stronger and more collaborative work environment that delivers better results. As an organization, it fuels our innovation and connects us closer to our associates, customers, and the communities we serve.

Schedule :

Full-Time