Posted in Other 30+ days ago.
Location: Watertown, Massachusetts
We enjoy the important work we do every day on behalf of our members.
Job Summary
The Manager of Inpatient Management is responsible for medical management activities related to utilization and discharge planning for acute inpatient, LTAC, rehabilitation and skilled nursing as well as Out of Network Management. S/he is accountable for implementation, monitoring and oversight of department functions and programs and the delivery of defined metrics to validate business unit/program effectiveness. The Manager of Inpatient Management works collaboratively with appropriate Tufts Health Plan departments and staff to identify and address opportunities to improve service, reduce administrative cost and demonstrate outcomes for functions and programs within jurisdiction. The Manager must have working knowledge of all THP product lines to provider cross coverage for other Clinical Services Inpatient Managers. The Manager works collaboratively with the divisional case management departments, contracted provider and employers to address opportunities to improve service to and optimize the business relationships, while meeting the Tufts Health Plan business and quality goals. The Manager of Inpatient Management partner's to support the delivery of services through integrated care teams to support an optimal wellness and care experience for the individual member. The Manager is accountable for recruitment, evaluation, management and development of Team Managers within jurisdiction. This position reports to the Director, Inpatient Management.Job Description
Business Process Implementation and Oversight
Accountable for development, implementation and effectiveness of new and existing Commercial and Public Plan medical management programs for inpatient utilization and discharge planning, including but not limited to:
Staff Development
Resource Management
Corporate Participation
Requirements
EDUCATION: (Minimum educations & certifications required)
BS degree in nursing required; Master's degree preferred (nursing, business, healthcare administration), or equivalent experience. Registered Nurse with current Massachusetts license preferred.
EXPERIENCE:
7 years of experience in managed care systems and operations.is required.
Demonstrate sound knowledge of utilization management and case management principles.
Experience will demonstrate a functional knowledge of utilization management within a variety of payment models
Expertise in business process changes and leading people is required.
SKILL REQUIREMENTS: (Include interpersonal skills)
Ability to work cooperatively as a team member across multiple levels within the organization
Results orientation to meet business goals
Critical and Analytic thinking - must understand cause and effect, internal and external impact of business changes and THP information systems
Influencing others - particularly those outside of direct reporting relationships
Strong communications skills (formal and informal, written and verbal)
Coaching and Mentoring - primarily of reports, but also of others
Must have commitment to excellence in customer service
Considers creative alternatives to traditional/conventional practices and takes risk when appropriate to the situation.
Regard for confidential data and adherence to corporate compliance policy
Ability to handle multiple demands--must be able to balance multiple priorities
WORKING CONDITIONS AND ADDITIONAL REQUIREMENTS (include special requirements, e.g., lifting, travel,
Overtime)
Requires initiative, sound judgment, and the ability to work under pressure in a constantly changing environment balancing multiple priorities and utilizing resources aggressively. Must be able to exercise appropriate judgment as necessary and raise issues to the appropriate level.
Strong computer skills required including proficiency in Excel, Word, PowerPoint and Visio
Travel required on an as needed basis. Occasional evening, weekend, early morning or extended day work may be required.
CONFIDENTIAL DATA: All information (written, verbal, electronic, etc.) that an employee encounters while working at Tufts Health Plan is considered confidential. Will be exposed to and required to deal with highly confidential and sensitive material and must adhere to corporate compliance policy and department guidelines/policies and all applicable laws and regulations at all times.
What we build together changes our customer's health for the better. We are looking for talented and innovative people to join our team. Come join us!
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