- Assists manager with operating MSHO program strategically for the growth and success of the program, employees and system partners.
- Utilizes knowledge of metro market, healthcare systems, trends and potential or actual changes that may affect program.
- Ensures program operates within Medicare, Medical Assistance and Federal Waiver programs rules and guidelines.
- Provides supervision and direction to MSHO staff.
- Assists manager with all MCO, DHS, CMS, HEDIS, TOC audits and audit outcomes.
- Continually assesses and improves the performance of care and services provided by the MSHO dept.
- Attends conferences, meetings as required.
- Maintains positive relationships with health plans and providers.
- Participates with community partners (MCO, DHS) in trainings, certifications, and value enhancement measures for successful outcomes.
- Acts as resource/liaison to clinic staff, clients, payer companies and government agencies regarding administration of contract provisions and regulations.
- Participates in Quality Management projects and PIP's with UMP, DHS, MCO's.
- Is available to give clinical supervision and direction to staff on a day to day basis.
- Sets an example of exemplary customer service standards.
- Continuously builds customer understanding by monitoring patient satisfaction performance through customer feedback.
- Continuously implements strategies to improve customer satisfaction.
- May carry small caseload to remain current with time management and work demands of care managers following all the mandates, criteria and requirements.
- Licensed RN in Minnesota. BLS. BSN.
- 7 years of nursing experience
- 3 years of Home Care or Case Management experience with extensive knowledge of Home and Community Based Services
- 1-2 years of geriatric case management
- Supervisory experience
- Home internet for laptop
- Transportation for home visits
- Computer skills
Supervisor MSHO Care Coordinator - Minneapolis, United States - University of Minnesota Physicians
Description
Why M Physicians?
Regardless of role, we recognize that every member of our team is vital The MSHO Care Supervisor helps to supervise the MSHO Program and oversees the managed care providers and staff, ensuring that all staff remain compliant with policies and mandates, and ensures proper communication of MSHO program. Leads and provides geriatric case management and coordination of care for defined enrollees within designated managed care organizations.
MSHO Managed Care Supervisor - Overview
Key responsibilities include but are not limited to:
1. Assists with leading and manage MSHO Program
2. Interprets related healthcare laws and regulations as they pertain to the various managed care contracts and Federal and state mandates.
3. Ensures high quality of care for members and good financial performance in the MSHO program.
4. Develops staff and ensure accountability.
Minimum Qualifications:
Location: Remote with expectation to drive for home visits
Hours: Full Time
Benefits: This is a fully benefit eligible position: Competitive wages, Healthcare (including vision & dental), 401K, parking & tuition assistance and more
University of Minnesota Physicians (M Physicians), a non-profit organization headquartered in Minneapolis, seeks motivated individuals for both clinical and non-clinical roles to drive innovation in health and medicine. Our inclusive culture offers competitive salaries, excellent benefits, and the opportunity for career development in the exciting field of health care to over 1,200 physicians, 300 advanced practice providers, and 2,200 health professionals and staff across Minnesota and beyond.
Join us on a mission to advance medicine.