naviHealth is the result of over a decade of dedicated visionary leaders and innovative organizations challenging the status quo for PAC management solutions. We do healthcare differently and we are changing healthcare one patient at a time. How might you ask? By hiring talented clinicians, engineers, analysts, and healthcare leaders to create and utilize cutting edge technology to provide the patient with the best level of care for the right amount of time.
Why Is This Role Critical?
The individual in this position will play a key role in developing and managing naviHealth’s Home Health Programs. The goal of these programs is to ensure that the members in the home health populations are receiving integrated medical, psychosocial, and mental health services in a cost-effective manner that meets their exceptional needs, primarily outside of the confines of a traditional health care setting. These programs focus on ongoing identification of members, development of multidisciplinary team approaches to meeting the complex needs of these members across a variety of settings including the members’ homes, daily collaboration with health care organizations and providers in the community, and a commitment to measurement of process, quality, and financial outcomes that meet triple aim objectives.
What you will be accountable for….
- Participate in collaborative coalition-building meetings with community partners, providing input relative to naviHealth’s strategic vision and objectives.
- Serves as a liaison between nH and home health consultants to develop appropriate workflows and operational model
- Serves as the primary SME to interact with GM’s regarding home health KPI’s and utilization metrics
- Provides internal monitoring on appropriate case review that is consistent with nH policy, regulatory guidelines and established guidelines
- Establishes productivity benchmarks for the home health utilization team for prospective and continued stay reviews
- Conducts operational meetings between nH and HH consultants as needed and brings appropriate issues/opportunities/updates to leadership
- Ensures staff understands and adheres to confidentiality policies, URAC, CMS, state and federal laws regarding the utilization management function.
- Help formulate and standardize processes that improve the clinical teams’ ability to address the needs of their assigned members and to communicate effectively with others providing services to these members
- Develop and monitor measures to improve the program’s effectiveness and efficiency of work processes
- Responsible for developing program clinical guidelines and operational workflows and ensure these guidelines are followed reliably.
- Provide on-going training to address programmatic and staff educational needs
- Provide orientation, and precept, new employees or provide oversight to staff who will provide the orientation or act as a preceptor
- Collaborate with others within the organization to ensure the successful integration of the program
- Ensures that performance (audit) reviews and productivity standards are met by staff.
- Demonstrate and adheres to Health Plan specific processes and all regulatory and accreditation requirements
- Review monthly dashboards, quarterly reports, and acute readmissions and other reports as needed to assist with the identification of opportunities for improvement.
- Attends management meetings to report on operations, re-hospitalizations, customer satisfaction, home health provider reports, utilization, and quality indicators.
- Keeps up to date on NCQA and URAC standards of practice
Management and Leadership
- Represent naviHealth at community stakeholder and coalition-building meetings.
- Assist with strategic planning and communication inside and outside the organization.
- Supervise assigned departmental staff
- Analyze work flow processes, organization of work and staffing needs and provide recommendations for decision making
- Assess staff needs for training, tools and other resources necessary to carry out their work and provide recommendations for decision making
- Ensure program expectations and standards are clearly understood by assigned staff
- Evaluate assigned employees’ performance both informally and formally and take corrective action to address any areas that need improvement
What you will need to be successful……
- Registered Nurse or Physical Therapist with a Bachelor’s degree in related field or combination of education and experience including pertinent clinical experience with 3-5 years of supervisory and program management experience required.
- 4-6 years of case management/utilization review experience preferred. Relevant professional experience in the areas of health and human services, care management of complex patients, chronic disease, counseling preferred. CCMC or ARN certification preferred.
- Experience in implementing programs, supervising staff and knowledge of the principles of quality improvement are also preferred.
- Creativity, flexibility, sound judgment, and ability to take initiative.
- Strong communication and writing skills and experience writing reports and synthesizing data.
- Excellent time management and organizational skills.
- Demonstrated ability to work as an effective team member and leader in a complex and fast-paced environment.
- Excellent interpersonal skills and demonstrated ability to interact professionally with culturally and educationally diverse staff and patients.
- Awareness of managed care concepts and principles, basic health plan operations and basic utilization management concepts, principles and practices
- Knowledge of care coordination concepts, principles and practices
- Ability to implement projects and to train staff to new processes and procedures
- Ability to develop and implement procedures and program standards
- Ability to use critical thinking skills in problem solving and formulate analytic questions
- Ability to work with multiple stakeholders or customers to effectively resolve issues
- Ability to use Microsoft Office and computer programs.
- Knowledgeable to InterQual and Milliman a plus
- Knowledgeable with NCQA and URAC standards a plus.
naviHealth is a pioneer in post-acute care and care transitions with a combined unprecedented 18 years of experience that uniquely positions us to manage patients, improve clinical and financial outcomes, and share risk with payors and providers. As a Cardinal Health company, we provide clinical support alongside scalable technology and advisory solutions that empower health systems, health plans, and post-acute providers to navigate care episodes across the continuum, with the goal of reducing waste and improving patient outcomes
We care about the people we serve.
We care about each other.
We care about our communities.
We embrace innovation.
We like simple.
naviHealth ™ is proud to be an equal opportunity/affirmative action employer. We are committed to attracting, retaining and maximizing the performance of a diverse and inclusive workforce. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or protected veteran status.
Cardinal Health is an Equal Opportunity/Affirmative Action employer.
All qualified applicants will receive consideration for employment without regard to race, color, religion, sex,
sexual orientation, gender identity, national origin, disability, or protected veteran status.