Clinical Program Manager

Join Martins Point Health Care - an innovative not-for-profit health care organization offering care and coverage to the people of Maine and beyond. As a joined force ofpeople caring for people Martins Point employees are on amission to transform our health care system while creating a healthier community. Martins Point employees enjoy an organizational culture of trust and respect where our values - taking care of ourselves and others continuous learning helping each other and having fun - are brought to life every day. Join us and find out for yourself why Martins Point has been certified as a Great Place to Work since 2015.

Position Summary

The Clinical Program Manager - Case Management leads strategic initiatives for the Generations Advantage and USFHP lines of this role you will design implement and oversee targeted programs aimed at improving care transitions reducing avoidable readmissions and enhancing post-discharge follow-up while ensuring strict compliance with regulatory requirements. Additionally you will champion our integrated whole-person care model by optimizing workflows and operational reporting. Acting as a key resource across the organization you will collaborate with cross-functional stakeholders to align clinical strategies with operational excellence and ongoing program success.

Job Description

PRIMARY DUTIES AND RESPONSIBILITIES

• Supports program development activities including operational reporting and program resources
• Translates organizational strategy into actionable localized case management work plans
• Streamlines case management workflows to eliminate clinical inefficiencies and improve member engagement
• Optimizes data reporting structures to track program metrics identifying trends that require clinical interventions
• Monitors program benchmarks and key performance indicators (KPIs) to measure the success of CM Program
• Ensures all clinical initiatives comply with TriCare CMS NCQA and other state or federal regulatory standards
• Identifies trends gaps and operational risks through performance monitoring
• Develops presentations communication and program tools in support of CM Program
• Partners with cross-functional leaders to align care model and implement new program initiatives
• Facilitates committees and working groups to communicate program updates barriers and financial outcomes
• Collaborates with IT and analytics teams to refine case management software platforms and reporting dashboards and scorecards.

Employees are expected to work consistently to demonstrate the mission vision and core values of the organization.

POSITION QUALIFICATIONS

Education:

• Bachelors Degree in Health Science Nursing or related field required.
• Masters degree in Business Administration (MBA) Healthcare Administration (MHA) or Public Health (MPH) preferred.

Licensure/certification:

• Certified Case Manager (CCM) or American Case Management Association (ACMA) certification preferred.

Experience:

• 10 years experience in healthcare including managed care with a focus in Program Management overseeing clinical programs and driving process improvement initiatives required.
• Experience using data and data analysis to design and monitor programs and manage success including ROI of programs required.
• Experience in evaluating financial and clinical performance metrics required.
• Experience in Medicare Advantage and TRICARE preferred.

Knowledge:

• Demonstrated experience with NCQA case management accreditation standards audit preparations and HEDIS quality metrics required.
• Proficiency in health IT systems including specialized Case Management platforms (e.g. TruCare Salesforce Health Cloud) Electronic Health Records (EHRs) and clinical data analytics reporting tools preferred.

Skills:

• Excellent communication and presentation skills oral and written.
• Strong organizational skills including the ability to work independently and prioritize work.
• Competence with computers and business applications; Microsoft Excel Visio Word PowerPoint Outlook Access.

Abilities:

• Demonstrated track record of driving new clinical programs through implementation and
• monitoring.
• Demonstrated expertise managing teams and multi-disciplinary workgroups in achieving team objectives without direct authority.
• Strong attention to detail and the ability to multitask.
• Ability to review interpret and present information to Health Plan Leadership and external partners.
• Ability to lead change and assist in the development of change strategies in support of Health Plan and Organizational goals and objectives.

Pay Range: $114957.40 - $142006.20 The pay range above reflects the anticipated base pay range based on a full-time position. Actual compensation will be determined based on factors such as experience skills qualifications and other job-related considerations. Employees may also be eligible for additional compensation including incentive or commission-based programs where applicable and subject to the terms of the relevant plan. In addition to base compensation we offer a comprehensive benefits package including medical dental vision retirement savings with employer contributions paid time off (including volunteer time off!) pie day and other employee benefits.

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