Gateway Health Plan
Job Description :
This job will develop, implement, and evaluate condition management programs that effectively impact Gateway Health Plan’s quality and financial goals, including but not limited to HEDIS, STARS, etc. Programs include member, provider and community components in multi-state environment for both the Medicaid and Medicare lines of business. These programs/interventions are designed to promote early identification, engagement and positive health outcomes for at-risk and high-risk members with chronic health conditions or pregnancy. Will monitor progress and provide reporting on overall performance of the condition management programs and initiatives.
- Partner/communicate effectively with all Gateway Health constituencies, which includes members, physicians, other health care professionals, internal departments, practitioners and community agencies to identify, educate and promote preventative health care initiatives and condition/disease specific educational programs.
- Collaborate/communicate with medical directors and other department managers to assure integration and coordination of the condition/disease management programs with the impacted departments’ ongoing programs and new initiatives.
- Direct and communicate with external contractors to support compliance and program/initiative roll-outs. Communicate with other health plans to research competitive practices or collaborate on disease specific health initiatives.
- Develop programs designed to promote timely and preventive care through targeted member and provider education and outreach. Identify new approaches to resolve complex issues.
- Monitor progress and provides reporting on overall performance of the disease management programs and related initiatives and recommend improvement opportunities for the disease management programs. Assure that all programs meet state and federal standards for health education and chronic care management, and recommends options for improving program performance. Maintains all documentation to support outcome evaluation and quality improvement functions.
- Conduct literature searches to identify innovative strategies and techniques aimed at member engagement, program enhancements and culturally relevant teaching materials and care management approaches. Maintain a strong working knowledge of clinical standards of care in specialty, and updates internal working documents accordingly.
- Assist in training initiatives for staff in case management around condition specific care, new technology and performance measures and outcomes. Provide training and education and develops health promotion materials taking into consideration the culturally diverse population that the organization serves.
- Convene interdepartmental workgroups which provide input for work plans and projects.
- Other duties as assigned or requested.
- Bachelor’s Degree in Nursing
In lieu of a Bachelor’s Degree, the requirement is to be a Registered Nurse (RN)
- 3 – 5 years’ experience developing clinical programs, patient education
- 3 – 5 years’ experience working in health promotions, healthcare marketing or health education
- 1 – 3 years’ experience working closely with local health departments or other community-level healthcare organizations.
- Addiction experience familiar with the levels of care that a person in addiction recovery is able to access, and in programming development and evaluation.
- Strong presentation and power point development skills.
KNOWLEDGE, SKILLS & ABILITIES
- Possess the ability to examine best practices, evaluate data, trends, provider opinions and member awareness for the purpose of trouble shooting and problem solving and making recommendations for improvement
- Must be able to effectively apply skills to identify, analyze and recommend interventions that will optimize the use of system and/or improve the quality of patient care
- Good communication skills
- Must be proficient in Microsoft Office products including Word, Excel and PowerPoint
- Presentation skills
LANGUAGE REQUIREMENT (other than English)?
0% – 25%
Registered Nurse (RN)
- Other Public Health (CPH)
- Case Management (CCM)
- Health Education (CHES)
PHYSICAL, MENTAL DEMANDS AND WORKING CONDITIONS
Position Type: Office-Based
An employee in this position works in an office environment. The position frequently requires the employee to communicate well with others both inside and outside the workplace (e.g., in person, via telephone, via email). The employee must be able to understand, interpret and analyze data, solve problems, concentrate, and research, use available technological resources and systems (e.g., computer programs), multi-task, prioritize, and meet multiple deadlines to complete essential tasks. The employee generally works in a fast-paced and frequently stressful environment, must attend work on a regular and reliable basis as well as adhere to all workplace policies, and may be called upon to work outside regular business hours.
Teaches / trains others regularly
Travel regularly from the office to various work sites or from site-to-site
Physical work site required
Lifting: up to 10 pounds
Lifting: 10 to 25 pounds
Lifting: 25 to 50 pounds
Disclaimer: The job description has been designed to indicate the general nature and essential duties and responsibilities of work performed by employees within this job title. It may not contain a comprehensive inventory of all duties, responsibilities, and qualifications required of employees to do this job.
Compliance Requirement: This position adheres to the ethical and legal standards and behavioral expectations as set forth in the code of business conduct and company policies
Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities, and prohibit discrimination against all individuals based on their race, color, religion, sex, national origin, sexual orientation/gender identity or any other category protected by applicable federal, state or local law. Highmark Health and its affiliates take affirmative action to employ and advance in employment individuals without regard to race, color, religion, sex, national origin, sexual orientation/gender identity, protected veteran status or disability.
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