Manager Transitions Team

Manager Transitions TeamNorthwest Physicians Network is now offering qualified candidates an opportunity to join our team as a Manager Transitions Team. Our company values innovative problem solvers promote personal and professional growth and provides a supportive working environment that affords all of its employees a healthy work/life balance. In support of NPN’s mission, vision, and strategic goals, the Department Manager is responsible for the Department program and all associated data, reports, auditing requirements, policies, procedures, and database management. This position is responsible for maintaining the department program and implementing changes and disseminating appropriate changes to all network practitioners, facilities and delegated groups. The Department Manager reports on program specifics, updates, and compliance. The Department Manager mentors and ensures all staff receive initial training and ensure continued department process requirements are met.Northwest Physicians Network creates the opportunity for independent private practitioners to thrive in Washington State. By providing clinical integration support and data driven quality improvement, we have created a high value delivery network, making it possible for our providers to remain focused squarely on their patients.Status: Regular, Full-time, FLSA ExemptCompetitive BenefitsPrimary responsibilities will include:Supports development of appropriate indicators for quality of utilization management, clinical outcomes and annual goals for achievement and supervises the development and implementation of clinical quality improvement, utilization management and complex case and disease management programs.

Determines needed levels of staffing to support the department and works with Director for approval.

Supervises and supports the recruitment and retention of high-quality staff for the department.

Develops clear standards and expectations for the professional performance of all department staff.

Establishes and maintains procedures for the measurement and evaluation of the department performance, provides coaching, counseling and discipline, when needed, for the department staff

Supports development of systems of support for staff well-being and job satisfaction.

Facilitates interdepartmental communications and problem solving.

Assures adequate data collection and health plan compliance with provision of the information necessary for care and cost management duties.

Collaborates with Director to develop annual operating budgets for the departments.

Set team direction, ensure team meets established performance metrics and performance guarantees

Implement and interprets organizational policies and procedures, reviews work of staff to ensure that policies and guidelines are appropriately applied

Support clinical operations across the continuum of care (assessing, planning, implementing, coordinating, monitoring and evaluating

Take lead role in setting direction and participating in or developing new programs

Maintains, develops and updates program policies and procedures including training materials, forms, letters, and associated reports

Prepares for oversight audits by the health plans and responds to delegation requests for the department

Identify gaps in care by routinely analyzing available data and support process improvement and impact from the assigned department

Facilitates understanding in the areas of case management, quality management, utilization management, member education and preventive health guidelines to promote health plan expectations and refers members for appropriate services

Acts as a resource to staff regarding the department including regulatory sources and compliance

Acts a resource and responds to questions from medical offices, hospitals, and members when questions relate to department functions

Assists in preparation of all delegation audit requirements

Adapt departmental plans and priorities to address business and operational challenges

Other Duties as assigned

Department Specific ResponsibilitiesUnderstands role in reducing hospital admissions and readmissions with timely clinical decisions of medical necessity and coordination of care with clinical teammates and outsider providers. 

Supports the delivery of cost-effective coordination of care, transition of care and utilization management.

Supports process of transition team responsibility to provide member care management services for high-risk members in alignment with clinical utilization review for delegated health plans and transition of care.

Work collaboratively with multiple disciplines and resources to facilitate transitions of care for the member.

Incorporates nursing process, standard work, critical decision-making skills and care management services while developing and implementing plan of care designed to meet the members 30-day post hospitalization needs while ensuring continuity of care.

Assess, facilitate, plan, and advocate for health needs on an individual basis resulting in quality, cost-effective outcomes. 

Plan and coordinate actives related to transition program

Ensures execution for High Risk transitional program

Leads Root Cause analysis for re-admits

Tracks/trends re-admits for process improvement

Knowledge, Skills, and AbilitiesAll staff members are to promote a positive and productive work environment by acting maturely and responsibly, satisfactorily performing his or her job responsibilities and conducting themselves in a professional, courteous and respectful manner toward fellow employees, physicians and members.

Knowledge of advanced best practice clinical standards, practices, and procedures for designated member population

Knowledge of Medicare, Medicaid and commercial payor guidelines

Consistent application of effective team leadership, mentoring and coaching skills

Demonstrates expertise in the application of InterQual/Milliman criteria

Knowledge and understanding of NCQA Guidelines

Consistent application of effective team leadership, mentoring and coaching skills

Knowledge of, and skill in, the use of personal computer and Microsoft Office Suite

Knowledge of age specific communication needs with the ability to listen actively and respond to internal and external customers in a timely, competent manner both verbally and nonverbally

Skill in teaching and nursing process

Ability to make presentations in a public setting

Ability to maintain confidentiality of member and all related entity business matters of the organization and its partners

Ability to maintain professional demeanor in resolving conflicts

Ability to work cohesively with team, members, physicians and medical staff to articulate complex concepts in managed care and coordinated care principles

The ability to interpret financial cost analysis reports

Minimum Requirements:Education: RN, BSN or above preferred from accredited nursing program

Experience: 3 years- broad-based clinical experience with increased leadership experience

Certification/License: Current unrestricted nursing license for the State of Washington, case management certificate preferred, mandatory after two years of employment. BLS current if working in clinic setting

Careers with Optum. Here's the idea. We built an entire organization around one giant objective; make health care work better for everyone. Optum, part of the UnitedHealth Group family of businesses, brings together some of the greatest minds and most advanced ideas on where health care has to go in order to reach its fullest potential. For you, that means working on high performance teams against sophisticated challenges that matter. Here you’ll find incredible ideas in one incredible company and a singular opportunity to do your life's best work.(SM) Diversity creates a healthier atmosphere: Optum and its affiliated medical practices are Equal Employment Opportunity/Affirmative Action employers and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law. Optum and its affiliated medical practices is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.