Utilization Management Associate Jobs in Grand Prairie, TX

Summary:

The Post Acute Care Supervisor will support the Team Leader in the overall vision of the ACO/CIN. They will oversee the daily operations of the post-acute programs, ensuring high-quality patient care and efficient workflows. This role involves leading nursing staff, developing new programs to reduce Post Acute spend, and implementing policies and procedures to maintain the highest standards of care while advocating for patients’ needs and preferences in care planning and the decision-making process.

Responsibilities:

• Meets expectations of the applicable OneCHRISTUS Competencies: Leader of Self, Leader of Others, or Leader of Leaders.

Leadership and Team Management:

• Supports leadership with day-to-day operations: including but not limited to selection, training, development, performance management, staffing, and productivity of associates within the Post Acute team for the ACO/CIN.
• Provide ongoing mentorship to associates to foster professional growth and development.
• Use performance metrics and expectations to objectively assess staff performance.
• Monitor post-acute spend for clinics assigned to each nurse and establish goals.
• Collaborate with manager on strategic plans to enhance team performance and achieve departmental goals.
• Fosters team engagement and drives performance management by recognizing and rewarding high achievers, while inspiring and motivating individuals to reach their full potential.
• Understands and supports "Triple Aim" objectives of an ACO/CIN and promotes these objectives in concert with organizational Core Values when supervising and leading the team.
• Optimize resource allocation to maximize efficiency and ensure team expectations are met.
• Maintains appropriate staffing ratios and team assignments based on volumes.
• Monitor compliance with regulatory requirements and organization policies.
• Responsible for HIPAA and Integrity compliance within the department.
• Responsible for the development and maintenance of policies and procedures for the team.
• Works closely with the department Manager and Director to identify and plan for opportunities for improvement within areas of responsibility.
• Monitors ACO/CIN post-acute spend across ministries for both employed and independent providers to ensure appropriate post-acute utilization and total cost of care.
• Oversees employed and independent provider participation in post-acute care programs.
• Engage with employed and independent providers to improve operational workflows.
• Integrate technology solutions to enhance communication and documentation processes.
• Develop partnerships with external organizations to expand new programs to reduce ACO/CIN high spend and collaborate and build relationships with Post Acute facilities.
• Identifies and collaborates with the manager to expand the post-acute care program.
• Identifies opportunities to enhance the post-acute care program and implement quality improvement initiatives to enhance patient care, outcomes, and reduce the total cost of care.
• Facilitate interdisciplinary collaboration with both other internal & external team members to ensure comprehensive patient care and efficient workflows.
• Manages a small case load of patients in collaboration with the Health Care Team.
• In coordination with the manager, develops tools, education, and workflow processes to assist the network in meeting CMS, ACO standards & initiatives.

Training and Development:

• Provide formal, structured orientation/training processes for new Associates with regular opportunities for feedback and assessment of competency upon completion.
• Conduct training sessions and professional development programs for nursing staff to promote continuous learning.
• Encourage continuing education and professional development opportunities for associates.
• Provide leadership training to prepare associates for future supervisory roles.
• Creates educational material for training.
• Conducts interdepartmental audits and provides feedback of staff to ensure appropriate documentation, policy & procedures compliance and standards are met.
• Implement strategies to promote a positive work environment.
• Address and resolve staff disputes and patient-related issues professionally.

Job Requirements:

Education/Skills

• Bachelor of Science in Nursing (BSN) preferred

Experience

• 4 years post-acute nursing experience, which includes home health, skilled nursing facility, inpatient rehab facility, and/or LTACH required
• 2 years in a supervisory role required
• 5 years supporting value-based care programs, accountable care organizations, or utilization management preferred
• Strong leadership, communication, and organizational skills; ability to manage multiple tasks and work under pressure required

Licenses, Registrations, or Certifications

• RN license in the state of employment or compact is required

In accordance with the CHRISTUS Health License, Certification and Registration Verification Policy, all Associates are required to obtain the required certifications for their respective positions within the designated time frame.

Work Schedule:

8AM - 5PM Monday-Friday

Work Type:

Full Time