SUPERVISOR, HOSPITAL TRAN COOR
Location: Easton Maryland
Description: CareFirst BlueCross BlueShield is at present recruited SUPERVISOR, HOSPITAL TRAN COOR right now, this position will be placed in Maryland. More complete informations about this position opportunity please read the description below. **This position requires travel to our Union Center Plaza - DC location based on business needs.
PURPOSE: The Hospital Transitions Coordination Supe! rvisor provides direct supervision to the Hospital Transitions Coordinators (HTC), Operations Coordinators, and Care Transition Specialist (CTS) as assigned. Supports the Transition of Care for targeted members, ensures the coordination and continuity of health care as patients transfer between different locations or levels of care. Accountable for improving the coordination of care between patients, providers and caregivers through communication and follow up. Ensures triage to the appropriate Programs, including Primary Care Medical Home (PCMH), Case Management, Alternative Care, Behavioral Health, Home Based Services, and Pharmacy to best address ongoing health needs of the member.
PRINCIPAL ACCOUNTABILITIES: This position reports to the Manager, Hospital Transitions Coordination. Primary accountabilities include, but are not limited to, the following:
Manages the delegation of assignments and supervises the Hospital Transitions Coordinators (HTC), Operati! ons Coordinators, and Care Transition Specialist (CTS) as assi! gned.
Routinely assesses and evaluates the Staff workloads/functions for compliance to process and standards, appropriateness in quality of work and productivity.
Monitors HTC daily functions to ensure appropriate coordination of health care services and compliance with Hospital Transitions Coordination policies/procedures, as well as, regulatory and CareFirst’s accreditation standards.
Assists/directs handling of complex cases to ensure appropriateness for documentation and inclusion of other internal departments, including but not limited to Care Management Programs, including Primary Care Medical Home (PCMH), Case Management, Disease Management, Physician Reviewers, Central Appeals, etc.
Collaborates and acts as a resource to the HTC staff and other internal customers regarding HTC processes, including, but not limited to, coordination of care, problem solving, benefit contracts, adverse decisions, or development of interdepartmental work flows.
Mee! ts with direct reports monthly to provide verbal and written feedback on Average # Visits/ Calls / day, and to review the levels assigned based on the monthly HTC dashboard/report card report.
Performs onsite visits/ or office meeting for telephonic staff for all assigned facilities each quarter
Actively participates in the development, design, and implementation of Hospital Transitions Coordination, care management processes and procedures or new CareFirst programs as assigned by Manager.
Maintains Hospital Transitions Coordination policies and procedures to ensure that the HTC processes and goals are supported; this includes an annual review of policies and procedures.
Maintains current knowledge of regulatory and/or accreditation standards. Ensures that the required elements for the standards are current and incorporated in the HTC processes.
Performs projects or other tasks as delegated. Uses/analyzes HTC data to provide insight regarding trends, sta! ffing, case load ratio, etc., that could impact the HTC process.
Pe! rforms projects or other tasks as delegated.
Applies CareFirst policies regarding associate performance, including, but not limited to, performance reviews/evaluations, corrective action plans, interviews/hiring.
Provides mentoring and guidance to develop, expand and improve associates’ skills and expertise.
Conducts individual and regular staff meetings to maintain ongoing communication.
Conducts inter-rater reviews, providing feedback on a quarterly basis or more often as indicated by performance.
Ensures that HTC associates have the information and resources needed to accomplish their assignments.
Works with HTC Supervisors and/or trainer to coordinate the orientation program for new associates, including evaluation of new associate performance as per HTC policy/procedures.
Communicates in a timely manner to Manager
Appropriate information including, but not limited to, customer/case issues, reports, trends/variances, action plans, etc. !
Meets routinely with peers, staff and/or Manager to communicate/update as pertinent.
Coordinates and collaborates with internal and external customers regarding CareFirst/HTC issues
Acts as a liaison with external customers to ensure coordination of care and services as appropriate for effective management of benefits and quality of care.
Plans and implements meetings with provider community to proactively facilitate change improve service and coordinate HTC activities.
QUALIFICATION REQUIREMENTS:
Requires a bachelor’s degree in Nursing or equivalent experience and must have 7-10 years of increasingly responsible hospital related experience working in Care Management, Discharge Coordination, Home Health, or Disease Management. Must have at least three years in a supervisory role or equivalent work experience in team leadership, training or project management. Must possess extensive knowledge of managed care delivery guidelines and syste! ms. Proven care management leadership experience is critical.
! Skills/Abilities:
Must have excellent analytical, oral and written communication, time management and organizational skills.
Must have effective presentation, negotiation and influencing skills to interface with all levels of management and physician practices.
Must be able to apply complex problem solving abilities to achieve problem and process solutions.
Must have the ability to work independently and proactively as well as with others on a team.
Must be able to positively interface with internal and external customers/providers.
Must have the ability to travel as required in accordance with business needs.
Must have working knowledge of Microsoft Office programs and web based computer systems.
The incumbent is required to have had the vaccinations and/or been appropriately screened (and cleared) for the items listed below. If the incumbent has not had them or been screened and cleared, they must do so upon acceptance of offer:
! TB screening (and repeat annually)
MMR-V Immunity
Hepatitis B vaccination
Influenza Vaccine (Seasonal)
The incumbent is required to complete the following training as assigned by Management, including, but not limited to:
Infection control basics
TB Awareness
Bloodborne Pathogens (and repeat annually)
- Required vaccinations/screenings and training requirements are subject to change based on hospital policies.
A current DC, MD, or VA Registered Nurse License is required.
Potential Job Hazards:
The position requires the Supervisors to make visits with their onsite HTC staff at inpatient hospital facility.
Incumbents are required to state their purpose upon arrival to the member’s room so there is no confusion as to their role vs. the role of the direct care hospital staff.
Incumbents do not provide any form ! of direct patient care.
Airborne Exposure:
There is! the potential for exposure to airborne illnesses, such as, but not limited to, tuberculosis, measles, mumps, rubella, varicella and influenza. The following administrative controls are in place to limit or minimize exposure potential:
Incumbents do not enter any inpatient rooms, or hospital rooms designated with Respiratory precautions, or where any procedures are being done that produce respiratory droplets.
Incumbents are required to remain at least 3 feet away from the inpatient member at all times.
Bloodborne Pathogens:
There is the potential for exposure to Blood borne Pathogens if not aware of surroundings at all times. The following administrative controls are in place to limit or minimize exposure potential:
Incumbents do not touch patients;
Incumbents must practice Universal Precautions at all times.
PREFERRED:
Thorough knowledge of CareFirst clinical guidelines, medical policies and accreditation and regulat! ory standards relating to transitional care/case management. Previous work experience within CareFirst Care Management. Working knowledge of CareFirst IT and Medical Management systems.
Department: Utilization Review
We are an Equal Employment Opportunity/Affirmative Action Employer and ADA compliant
www.carefirst.com/careers
Please apply before: August 4, 2013
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If you were eligible to this position, please email us your resume, with salary requirements and a resume to CareFirst BlueCross BlueShield.
If you interested on this position just click on the Apply button, you will be redirected to the official website
This position starts available on: Tue, 30 Jul 2013 03:59:02 GMT