JOB SUMMARY: Â|
· Functions as a member of the Physician Enterprise Innovative Care team providing direction and leadership throughout the St. Vincent Physician Enterprise related to the development, implementation and workflows related to utilization, population management and care management initiatives that increase patient engagement, improve staff productivity and optimize financial and clinical efficiency. Â
· Responsible for the development, implementation and monitoring of utilization and care management activities. Â
· Represent St. Vincent Physician Enterprise with external entities on matters related to utilization, population management and care management activities as directed. Â
· Support physicians and interdisciplinary team in facilitating patient care to enhance the quality of clinical outcomes and patient satisfaction while managing the cost of care and providing timely and accurate information to payors.
1. Serves as the lead in the development of the SVMG Care Management project design. Demonstrates understanding of emerging healthcare delivery models. Program design model will include but not limited to: Management of Care for Patients with High Health Care Needs.
Access to Care 24/7 utilizing patient data tools to provide real-time, personal healthcare information to patients.
Delivery of appropriate and timely preventive care.
Engagement of patients and caregivers to actively participate in their care.
Coordination of care across medical specialties through a medical team approach.
2. Develop standardized processes to implement the SVMG Care Management program.
Develop, implement, monitor and modify utilization and care management operations, consistent with benefit design, product design, reimbursement methodology and network design.
Design processes and programs to appropriately reduce medical costs and increase quality of care to patients.
Lead and support network, quality programs, medical policy process and credentialing as needed.
Chair committees related to both processes internal to Care Management but also those that monitor and integrate cross functional processes across the Enterprise.
Perform routine duties associated with utilization, risk, case and care management, grievances and appeals as assigned.
Respond to measures of clinical managed care performance using quality management statistics and interventions.
Interface with physicians, facilities and other providers as necessary
Support workgroups, committees and task forces as assigned.
Ensure compliance with regulatory requirements.
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