Shire Jobs

[We offer remote work opportunities (AK, AR, AZ, CA, *CO, FL, *HI, IA, ID, IL, KS, LA, MD, MN, MO, MT, NE, NV, NM, NC, ND, OK, OR, SC, SD, TN, TX, UT, VA/DC, *WA, WI and WY only). [Our Department of Defense contract requires US citizenship and a favorably adjudicated DOD background investigation for this position. [Must be a U.S. Citizen [Veterans, Reservists, Guardsmen and military family members are encouraged to apply!

Job Summary]{calibri",sans-serif"=""}]{arial",sans-serif"=""}]{calibri",sans-serif"=""}]{calibri",sans-serif"=""}

Responsible for leading and directing a team of clinicians and health coaches that provide integrated Population Health (PH) and Disease Management (DM) program services and interventions for our beneficiaries under the direction of the Manager of Disease Management. The Supervisor is responsible for applying specific program and contractual guidelines to provide an integrated whole health service that improve healthcare outcomes and healthcare experiences to beneficiaries. Daily collaboration with the Manager of Disease Management and Director of Population Health is required to manage and develop clinical program components to optimize Population Health strategies and goals, and develop and implement policies and procedures to ensure compliance with URAC accreditation standards.

Education and Experience

Required:

Bachelors degree in Nursing or Social Work Current, unrestricted RN or LCSW license to independently work within scope of practice for the discipline within state of residence. The ability to obtain multi-state licensure; if required If supporting TRICARE contract, must be a U.S. Citizen If supporting TRICARE contract, must be able to receive a favorable Interim and adjudicated final Department of Defense (DoD) background investigation Minimum of three years clinical experience with progressively responsible leadership experience in Population Health, Case or Disease Management operations and program development in a Managed Care Organization (MCO) or healthcare system Preferred:

Master's Degree in Nursing or Social Work Multi-State Licensure Direct experience in Managed Care, Population Health, Population Analytics or Wellness programs in a Managed Care Organization (MCO) Knowledge of government health care programs, TRICARE and/or Medicare/Medicaid Knowledge of ICD-10, CPT and HEDIS is a plus Experience in developing training, policies, procedures and desk procedures Proficient with computers and Microsoft Office suite of applications

Key Responsibilities

Monitors day-to-day operations of the Disease Management and Population Health team to identify barriers to providing excellent service to TRICARE beneficiaries. Systematically evaluates the quality and effectiveness of staff performance, analyzing appropriate data and information to identify areas of improvement; advises and coaches when appropriate and completes annual performance appraisals. Manage activities necessary to ensure appropriate utilization of resources while maintaining optimal achievable standards of care. Supports the implementation of orientation and training of new-hire employees. Ensure adherence to URAC standards, TRICARE policy, contractual requirements, and nationally recognized practice standards. Participates in development of desk procedures, education and auditing to support uniform application of programs and compliance with program policy and standards. Reviews referrals for Disease Management for appropriateness of program requirements. Participates in the management of beneficiaries condition(s) by identifying problems, anticipating complications, addressing educational needs and SDoH resources and reinforcing tr atment plans and orders. Assists in facilitation of beneficiary transfer between the different regions and within the region by collaborating with the military liaison to transition the beneficiary with minimal disruption of health care services. Performs other duties as assigned o Promotes health and education methods and encourages beneficiary and family involvement in patient care and treatment. o Identifies potential clinical service, risk management and quality issues with referral to the appropriate review organization. . o Participates on committees as directed by management. o Performs other duties as assigned. o Regular and reliable attendance is required.

Competencies

Coaching / Training / Mentoring: Actively foster actions required for desired business outcomes through ongoing constructive feedback. Communication / People Skills: Ability to influence or persuade others under positive or negative circumstances; adapt to different styles; listen critically; collaborate. Computer Literacy: Ability to function and demonstrate proficiency in Microsoft Office suite of applications, clinical program systems, and TriWest Intranet. Coping / Flexibility: Resiliency in adapting to a variety of situations and individuals while maintaining a sense of purpose and mature problem-solving approach is required. Delegation Skills: Provide clear performance expectations for projects and ensure adequate access to resources for completion. Organizational Skills: Ability to organize people or tasks, adjust to priorities, learn systems, within time constraints and with available resources; detail-oriented. Problem Solving / Analysis: Ability to manage large amounts of complex information, communicate clearly, and draw sound conclusions. Team-Building / Team Player: Influence the actions and opinions of others in a positive direction and build group commitment.