Details
Posted: 18-Jun-22
Location: Danville, Pennsylvania
Type: Full Time
Salary: Open
Categories:
General Nursing
Job Summary
Provides clinical and operational oversight of Medical Management. Serves as a resource for communication and access to services for staff, customers and other internal/external customers of Medical Management. This includes medical management, population analysis, determination of coverage, member steerage, transitions of care coordination, process improvement strategies, barrier analysis and data management. Reviews, develops, and provides on-going training and educational tools to staff. Assists with site visits, plans, directs and controls activities to meet operational needs.
Job Duties
- Manages day to day operations with Medical Management staff to ensure effective member-centric delivery of medical management, resource utilization intervention, coordinated transitions of care, member steerage and other medical management strategies.
- Monitors operational performance within Medical Management using a variety of feedback reports related to quality and efficiency outcomes.
- Meets with staff on regular basis to evaluate operational performance.
- Responds to deficiencies with appropriate modifications in strategy.
- Researches and resolves process issues.
- Assists in evaluation and implementation of effective information management systems.
- Allocates staff coverage to provide optimal utilization of staff resources.
- Assists with orientation of new staff and monitors progress during orientation according to department standards.
- Conducts assessment of current workflows, division of labor, barrier analysis and suggested strategies for practice change.
- Oversees and provides education to facilitate practice knowledge of medical management strategies, role and responsibility of team, medical management tools, etc.
- Leads in the ongoing process improvement and implementation strategies designed to improve quality and efficiency outcomes.
- Monitors and analyzes utilization and quality metrics to recommend and implement change strategies to improve overall staff and medical cost efficiency.
- Identifies opportunities with other systems of care to identify and eliminate barriers and implement improvement strategies designed to improve transitions of care.
- Supports development of short and long term strategies as well as overall goals for medical management.
Work is typically performed in a clinical environment. Accountable for satisfying all job specific obligations and complying with all organization policies and procedures. The specific statements in this profile are not intended to be all-inclusive. They represent typical elements considered necessary to successfully perform the job. Additional competencies and skills outlined in any department-specific orientation will be considered essential to the performance of the job related to that position.
Position Details
*Geisinger offers a comprehensive suite of healthcare benefits all starting day one of employment! This includes medical, prescription drug, vision and dental coverage. We also offer up to $5,000 tuition reimbursement and 5% contribution to your retirement plan.
Education
Master's Degree-Social Work (Required)
Experience
Minimum of 4 years-Related work experience (Required)
Certification(s) and License(s)
Licensed Social Worker - Default Issuing Body
OUR PURPOSE & VALUES: Everything we do is about caring for our patients, our members, our students, our Geisinger family and our communities. KINDNESS: We strive to treat everyone as we would hope to be treated ourselves. EXCELLENCE: We treasure colleagues who humbly strive for excellence. LEARNING: We share our knowledge with the best and brightest to better prepare the caregivers for tomorrow. INNOVATION: We constantly seek new and better ways to care for our patients, our members, our community, and the nation. SAFETY: We provide a safe environment for our patients and members and the Geisinger family We offer healthcare benefits for full time and part time positions from day one, including vision, dental and domestic partners. Perhaps just as important, from senior management on down, we encourage an atmosphere of collaboration, cooperation and collegiality. We know that a diverse workforce with unique experiences and backgrounds makes our team stronger. Our patients, members and community come from a wide variety of backgrounds, and it takes a diverse workforce to make better health easier for all. We are proud to be an affirmative action, equal opportunity employer and all qualified applicants will receive consideration for employment regardless to race, color, religion, sex, sexual orientation, gender identity, national origin, disability or status as a protected veteran.
We are an Affirmative Action, Equal Opportunity Employer Women and Minorities are Encouraged to Apply. All qualified applicants will receive consideration for employment and will not be discriminated against on the basis of disability or their protected veteran status.
