Regional Disease Management & Clinical Documentation Program Lead

Job Summary:

The Regional Disease Management (DM) and Clinical Documentation Program Lead is responsible for supporting the development, management, and delivery of DM programs, materials, and Care Management clinical documentation company-wide

Essential Functions:

• Assist in the development and design of scalable, replicable, best practice, evidence-based disease management programs that target and achieve quality, enrollment and retention
• Assist with the development of Care Management clinical documentation including policies and procedures and process flows/e-manuals.
• Ensure clinical documentation and programs comply with NCQA standards
• Facilitate and promote problem identification, analysis and resolution
• Develop and support relationships with internal stakeholders and external vendors
• Oversee ongoing process improvement to include up to date documentation of all care management and disease management policies, procedures and SOPs
• Respond to requests from various departments and collaborate on projects and pilots
• Collaborate with internal business owners to integrate care management and disease management content into digital solutions
• Analyze membership, enrollment and utilization data to identify populations within membership that would benefit from a focused disease management program
• Support the vendor management team with the oversight and management of CareSource’s relationships with disease management vendors Monitor and evaluate the efficiency and effectiveness of disease management activities through analysis and use of relevant data and management reports
• Perform any other job duties as requested

Education and Experience:

• Bachelor’s degree in nursing, health education or related field or equivalent years of relevant work experience is required
• Master’s degree in public health or health administration is preferred
• A minimum of three (3) years of experience within the healthcare industry is required
• Minimum of one (1) year of experience in program development and implementation required
• Minimum of one (1) year of experience in data analysis is preferred
• Managed care experience preferred

Competencies, Knowledge and Skills:

• Advanced level skills in Microsoft Word, Excel and PowerPoint
• Ability to plan, promote, implement and evaluate programs
• Ability to work independently and in a team environment
• Solution-focused, process management skills
• Ability to effectively organize and prioritize multiple initiatives
• Excellent oral, written and interpersonal communication skills
• Analytical skills
• Attention to detail
• Knowledge of evidence based research and interventions
• Knowledge of regulatory reporting and compliance requirements

Licensure and Certification:

• Current, unrestricted Registered Nurse (RN) licensure in the state of practice is preferred

Working Conditions:

• General office environment; may be required to sit or stand for extended periods of time

Compensation Range:

CareSource takes into consideration a combination of …