Experience Inc. Jobs

FIND YOUR FUTUREWe're excited about the potential people bring to our organization. You can grow your career here while enjoying first-class perks, benefits and commitment to diversity and inclusion.OverviewThe Clinical Manager, Medicare, will be responsible to assist the Director, Case and Disease Management with the planning, implementation, development, and ongoing evaluation of projects and programs related to Independent Health Medicare membership. Such projects and programs will be designed to improve the health status of IHA members through targeted clinical interventions through the administration of quality improvement functions. The Clinical Manager will also be responsible for direct supervision of the Medicare clinical team.Qualifications- Bachelor's degree required. An additional four (4) years of experience will be considered in lieu of degree.- Current, active, unrestricted, and registered nursing (RN) license, licensed master's social worker (LMSW), master's in social work (MSW), or licensed dietician with Case Management experience required.- Case Management Certification (CCM) required. Candidates without CCM certification are required to obtain it within 2 years of commencing employment.- Five (5) years of experience in a clinical setting, working with low socioeconomic populations required.- Two (2) years of leadership/management responsibility required.- Knowledge of managed care policies and procedures with focus on Medicare regulations.- Excellent interpersonal, verbal, and written communication skills- Ability to work effectively as a member and leader of a multi-disciplinary team. Ability to lead or influence others positively to achieve desired work results and ability to work effectively with others to achieve desired goals.- Ability to collect and analyze outcomes against established benchmarks/standards.- Ability to build collaborative relationships with community agencies and resources.- Ability to coordinate a quality cost-effective care management system for low-income members.- Proven examples of displaying the IH values: Passionate, Caring, Respectful, Trustworthy, Collaborative and Accountable.Essential AccountabilitiesLeadership- Develop and monitor individuals responsible for providing case/disease management, preventive health care, and management of high-risk members in alignment with the Independent Health strategic goals to improve clinical quality and overall efficiency.- Maximize productivity and provide opportunities for professional growth and development to achieve departmental goals.Program Development and Coordination- Lead staff in the assessment for and the development, implementation and evaluation of disease/case management programs in support of the Independent Health quality improvement plan.- Ensure that the population segments meet the goals for utilization, cost and quality by coordinating, developing, implementing and evaluating the following: initiatives to identify high-risk members; day-to-day clinical operations of the state government programs; and case management efforts as put forth by the Health Care Services department to include chronic disease management (Heart Failure, COPD, CAD, Diabetes, Asthma) and acute care facilities utilization.- Work with case management team and providers to develop collaborative strategies for management of special populations.- Oversee the staff in the use of the six essential activities of case management, which include assessment, planning, implementation, coordination, monitoring, and evaluation.- Assist in establishing and revising departmental policies and procedures to be communicated to internal and external customers. Assist in the completion of monthly/annual utilization case management reports.Reporting Data- Identify areas and communicate opportunities regarding the products against monthly and quarterly financial/utilization performance to budget.- Identify areas and communicate opportunities regarding the products against monthly and quarterly financial, utilization and quality performance benchmarks.- Update product operations team on key initiatives and clinical performance programs resulting from utilization data and reports.- Develop and maintain statistical reporting of clinical outcomes for disease/case management programs.Hiring Compensation Range: $90,000 - $110,000 annuallyCompensation may vary based on factors including but not limited to skills, education, location and experience.In addition to base compensation, associates may be eligible for a scorecard incentive, full range of benefits and generous paid time off. The base salary range is subject to change and may be modified in the future.As an Equal Opportunity / Affirmative Action Employer, Independent Health and its affiliates will not discriminate in its employment practices due to an applicant's race, color, creed, religion, sex (including pregnancy, childbirth or related medical conditions), sexual orientation, gender identity or expression, transgender status, age, national origin, marital status, citizenship and immigration status, physical and mental disability, criminal record, genetic information, predisposition or carrier status, status with respect to receiving public assistance, domestic violence victim status, a disabled, special, recently separated, active duty wartime, campaign badge, Armed Forces service medal veteran, or any other characteristics protected under applicable law. for additional EEO/AAP or Reasonable Accommodation information.Current Associates must apply internally via the Job Hub app.As an Equal Opportunity / Affirmative Action Employer, Independent Health and its affiliates will not discriminate in its employment practices due to an applicant’s race, color, creed, religion, sex (including pregnancy, childbirth or related medical conditions), sexual orientation, gender identity or expression, transgender status, age, national origin, marital status, citizenship, physical and mental disability, criminal record, genetic information, predisposition or carrier status, status with respect to receiving public assistance, domestic violence victim status, a disabled, special, recently separated, active duty wartime, campaign badge, Armed Forces service medal veteran, or any other characteristics protected under applicable law. Click here: https://www.independenthealth.com/AboutIndependentHealth/Careers/AdditionalEEO-AAPInformation for additional EEO/AAP or Reasonable Accommodation information.