Manager Clinical Care Coordination

Highmark Bcbsd Inc.
JOB SUMMARY
This job manages and coordinates the training and education staff and program for the care coordination, utilization review, and quality management teams. Monitors and evaluates the operational performance of overall training departmental direction, leveraging analytics, regional market trends and utilization trends of members to set future direction and refine current state. Develops longer term staff training and education plans that will improve staff knowledge re: utilization management, quality and clinical outcomes based on market trends, legislative environment and company’s mission, vision and direction. The incumbent is responsible for the leadership, performance management and training of staff as well as company and department objectives, supporting education of staff who perform care coordination in a variety of health care settings to appropriately identify members with chronic conditions and/or gaps in care that can be positively impacted related to quality and care costs. (note that health care settings could include, but not limited to, working in a physician’s office, visiting physician practices on a routine basis, working within a hospital setting and/or assessing and coordinating member’s care within the member’s home).
ESSENTIAL RESPONSIBILITIES
QUALIFICATIONS
Minimum
Preferred
Skills
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.
As a component of job responsibilities, employees may have access to covered information, cardholder data, or other confidential customer information that must be protected at all times. In connection with this, all employees must comply with both the Health Insurance Portability Accountability Act of 1996 (HIPAA) as described in the Notice of Privacy Practices and Privacy Policies and Procedures as well as all data security guidelines established within the Company’s Handbook of Privacy Policies and Practices and Information Security Policy.
Furthermore, it is every employee’s responsibility to comply with the company’s Code of Business Conduct. This includes but is not limited to adherence to applicable federal and state laws, rules, and regulations as well as company policies and training requirements.
Referral Bonus: Level 1
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