Essential Duties and Responsibilities 

Includes the following. Other duties may be assigned. 

• Manage the day-to-day operations of Value Based Care clinical programs to improve quality, patient outcomes, and operational efficiency. 

• Analyze utilization and population health data to identify opportunities for improved outpatient management and reduced inpatient and emergency department utilization. 

• Develop, implement, and monitor population health initiatives for Value Based beneficiaries. 

• Provide oversight and guidance for high-risk patient case management activities with a focus on reducing preventable emergency department visits, hospital admissions, and readmissions. 

• Supervise and support the multidisciplinary care team, including Case Managers, Social Services staff, Emergency Department Follow-Up Coordinators, Care Coordinators, and Transitional Care Management Nurses. 

• Ensure effective transitions of care for patients discharged from hospitals, skilled nursing facilities, rehabilitation centers, and behavioral health facilities by coordinating:  

• Primary Care Provider follow-up appointments 

• Specialist referrals 

• Home Health services 

• Durable Medical Equipment (DME) 

• Community resource and social service support 

• Monitor and address quality measure performance and care gaps to support organizational quality goals. 

• Develop and facilitate Value Based Care education and training programs for patients, providers, and staff. 

• Participate in quality improvement committees, provider meetings, hospital operational meetings, and other organizational initiatives as required. 

• Monitor organizational strategies and performance metrics to support clinical, operational, financial, and utilization management goals. 

• Lead the successful integration of Value Based Care programs into existing workflows and operational processes. 

• Build and maintain collaborative relationships with providers, community partners, hospitals, post-acute facilities, and other key stakeholders. 

• Identify and implement process improvement opportunities that align with organizational objectives and strategic initiatives. 

• Travel to provider offices, care teams, and organizational sites as needed to provide education, support, and program oversight. 

Competencies 

To perform the job successfully, an individual should demonstrate the following competencies: 

Analysis and Problem Assessment 
Ability to gather, analyze, and interpret data to identify trends, gaps, root causes, and opportunities for improvement. 

Compassion 
Demonstrates empathy, respect, and commitment to patient-centered care while maintaining confidentiality and professional standards. 

Compliance 
Maintains knowledge of and adheres to all organizational policies, regulatory requirements, compliance standards, and the Code of Conduct. 

Communication 
Communicates clearly and effectively in verbal and written formats. Demonstrates strong listening skills and adapts communication style to various audiences. 

Dependability 
Consistently meets deadlines, commitments, attendance expectations, and operational responsibilities while maintaining accountability for results. 

Leadership and Influence 
Motivates, coaches, and develops team members while promoting collaboration, accountability, and continuous improvement. 

Innovation 
Identifies creative solutions and opportunities to improve workflows, patient outcomes, and operational effectiveness. 

Integrity 
Demonstrates honesty, professionalism, ethical decision-making, and adherence to organizational values. 

Judgment and Problem Solving 
Makes informed, timely decisions by evaluating relevant information, identifying risks, and addressing issues proactively. 

Performance Management 
Establishes clear expectations, provides feedback and coaching, supports staff development, and evaluates performance effectively. 

Organizational Awareness 
Understands organizational priorities, operations, culture, and stakeholder relationships to achieve strategic objectives. 

Patient Service Orientation 
Promotes exceptional patient experiences through proactive engagement, advocacy, responsiveness, and effective problem resolution. 

Planning and Organization 
Prioritizes workload, allocates resources effectively, and manages multiple initiatives to achieve desired outcomes. 

Results Orientation and Execution 
Demonstrates accountability for achieving departmental and organizational goals while driving measurable outcomes. 

Teamwork and Collaboration 
Works effectively across departments and disciplines, fostering positive relationships and shared accountability for success. 

Work Standards 
Maintains high standards of performance and professionalism while encouraging excellence within the team. 

Qualifications 

To perform this position successfully, an individual must be able to perform each essential duty satisfactorily. Reasonable accommodations may be made to enable qualified individuals with disabilities to perform the essential functions. 

Education and Experience 

• Bachelor's degree in Nursing, Healthcare Administration, Public Health, or a related field preferred. 

• Minimum of three to five years of clinical care management, population health, utilization management, or Value Based Care experience preferred. 

• Prior leadership or supervisory experience preferred. 

• Equivalent combinations of education and experience may be considered. 

Language Skills 

• Ability to read, analyze, interpret, and communicate complex healthcare information. 

• Ability to effectively address sensitive inquiries from patients, providers, staff, and business partners. 

Mathematical Skills 

• Ability to apply basic mathematical concepts and interpret healthcare utilization and performance data. 

Reasoning Ability 

• Ability to identify problems, evaluate information, develop solutions, and make sound decisions in complex situations. 

Computer Skills 

• Proficiency with Electronic Medical Records (EMR), preferably Athena. 

• Proficient with Microsoft Office applications, including Word, Excel, Outlook, and PowerPoint. 

• Experience utilizing population health, reporting, and care management platforms preferred. 

Certificates, Licenses, and Registrations 

• Current Registered Nurse (RN) license in good standing. 

• Case Management Certification (CCM, ACM, or equivalent) preferred. 

• Valid driver's license and reliable transportation, if travel is required. 

Physical Demands 

The physical demands described are representative of those required to successfully perform the essential functions of this position. Reasonable accommodations may be made for qualified individuals with disabilities. 

While performing the duties of this position, the employee is regularly required to sit, stand, walk, communicate, and use hands to operate office equipment and technology. Occasional bending, reaching, stooping, and lifting of up to 10 pounds may be required. Specific vision abilities include close vision, distance vision, peripheral vision, depth perception, and the ability to adjust focus. 

Work Environment