Population Health Management Supervisor RN

University Health

San Antonio, TX

JOB DETAILS
SKILLS
Acute Care, Business Operations, Case Management, Cross-Functional, Current Procedural Terminology (CPT), Customer Support/Service, Department of Health and Human Services, Diagnosis-Related Group (DRG), Establish Priorities, Funding, Health Education, Health Information Management, Health Maintenance Organization (HMO), Health Plan, Healthcare, Healthcare Software, Insurance, International Classification of Diseases (ICD), Licensed Practical Nurse/Licensed Vocational Nurse, Managed Care, Medicaid, Medical Coding, Metrics, National Committee for Quality Assurance (NCQA), Nursing, Outpatient Care, Patient Care, People Management, Project/Program Management, Quality Management, Registered Nurse (RN), Six Sigma, Team Player
LOCATION
San Antonio, TX
POSTED
30+ days ago

POSITION SUMMARY/RESPONSIBILITIES Provides supervision of quality activities delivered and facilitates the health care team meeting UMA strategic goals and established metrics for the assigned patient population/s. Provides professional level skills affording direct and indirect services to clients and working with a multidisciplinary team to streamline data submission to managed care plans, educate Physicians and Advanced practice providers and promote optimal well-rounded care for assigned patient population in the outpatient setting. Establishes priorities for self and peers, ensuring that services are rendered in a prompt, efficient and effective manner. Actively supports the policies and procedures of UMA and University Health. EDUCATION/EXPERIENCE Five years of applicable experience required with a Licensed Vocational Nurse (LVN); OR six years of applicable experience with an Associates of Science in Nursing (ASN); OR five years of applicable experience required with a Bachelors of Science in Nursing (BSN) *Applicable experience for this position is defined as, but not limited to, experience in acute care, quality management, managed care, medical operations or business operations/settings. Knowledge of coding resources (DRG, ICD and CPT) and Medical Information/Medical Management Systems is required. Knowledge of Medicaid, community resources, alternate funding programs, Texas Health and Human Services Commission and Texas Department of Insurance HMO standards and NCQA in a managed care setting is required. Supervisory experience is preferred. LICENSURE/CERTIFICATION Clinicians serving as a supervisor must hold/maintain current licensure requirements in his/her specialty with the State of Texas. All staff serving as a supervisor must maintain a current certification from an appropriate professional agency (such as Case Management Society, Six Sigma, Project Management, etc.) or must be obtained within 24 months of accepting the position.

About the Company

U

University Health