Clinical Management Supervisor
Responsible for the development and execution. Manage vulnerable population, chronic illness patients to promote effective education, self-management support and timely healthcare delivery to achieve optimal quality and financial outcomes. Coordinate patient care to improve quality of care through the efficient use of resources and thereby enhancing quality, cost-effective outcomes. Acts as an advocate for an individual’s healthcare needs, and coordinates care to minimize the fragmentation of health care delivery systems. Assist monitoring programs, ownership of policies and procedures and ongoing of metrics with program remediation as necessary.
- Develop and implement policies, processes and benchmarks that support ongoing improvement of clinical operations and promote quality, process evaluation, design approach for model of care requirements and plans for special populations.
- Collaborates in identifying appropriate patients for care management, utilizing established care management criteria.
- Performs periodic holistic assessments for care managed population. Prioritize patients according to intensity, need and required follow up.
- Formulates and implements a care management plan that addresses the patient’s identified needs by issues, resources and care goals; determining the choices available to individual patients; educating the patient/family on the choices available.
- Evaluates the effectiveness of the plan in meeting established care goals; revises the plan as needed to reflect changing needs, issues and goals. Monitors and evaluates the progress of the patient.
- Collaborates with the clinical team to revise the care management plan when changes occur.
- Discuss with the multidisciplinary team responsibilities, patient progress, new problems, among others.
- Review of model of care data to determine indicators for identifying opportunities for improvement.
- Ensure compliance with CMS by ensuring adherence to the model of care program, whether internal or externally led; works with management to develop remediation plans as necessary.
- Assist in internal and external audits.
- Play a Subject-matter expert role for model of care and process troubleshooting.
- Develops and executes processes and tools for the program as needed.
- Ensure appropriate resource allocation, maintained operational controls and maximized efficiencies.
- Determine the cost-effectiveness of the program and the quality of the services offered, compiling and evaluating statistical and economic data and converting them to execution and service indicators.
- Participates in the implementation of tactical plans, follows up on assigned tasks, projects, or objectives to ensure that expectations are met.
- Prepares production reports, statistics and presentations when required.
- Assist in special projects and / or initiatives of the corporation.
- Provide recommendations to achieve the Division’s and Company’s goals.
- Hires, trains, coaches, counsels, motivates and evaluates the performance of direct reports. Establishes disciplinary actions when necessary and promotes employee performance recognition when applicable.
- Responsible for preparing, assigning tasks, monitoring workflow and monitor day to day execution and employee activities.
- Other tasks as assigned by management and that are essential.
Current/ valid nursing license in good standing or without restrictions.
Member of College of Nursing Professional of Puerto Rico
Clinical Management Certifications, preferable.