Clinical Manager, Care Management & TOC

Prominence Health is a value-based care organization bridging the gap between affiliated health systems and independent providers, building trust and collaboration between the two. Prominence Health creates value for populations and providers to strengthen integrated partnership, advance market opportunities, and improve outcomes for our patients and members. Founded in 1993, Prominence Health started as a health maintenance organization (HMO) and was acquired by a subsidiary of Universal Health Services, Inc. (UHS) in 2014. Prominence Health serves members, physicians, and health systems across Medicare, Medicare Advantage, Accountable Care Organizations, and commercial payer partnerships. Prominence Health is committed to transforming healthcare delivery by improving health outcomes while controlling costs and enhancing the patient experience.

Learn more at: https://prominence-health.com/

Job Summary: This position is responsible for the day-to-day management of the Care Management (CM) program, D-SNP Care Management Program, and Transitions of Care. The position entails staff supervision and personnel management in the department. The Clinical Manager is responsible for the implementation of and management of a comprehensive Care Management and Transitions of Care Program.  

The Clinical Manager is responsible for the implementation, and management of a comprehensive Case Management program that is accountable for the management of members with catastrophic/complex conditions. The Clinical Manager is responsible for managing a staff of Registered Nurses, Licensed Clinical Social Workers, and non-clinical staff, who utilize the Case Management process to 1) assess the health care needs of the member; 2) develop a comprehensive treatment plan complete with specific goals and objectives; 3) implement a treatment plan in collaboration with the PCP and the other providers involved in the patient’s care; 4) negotiate and coordinate services for the patient; 5) monitor and evaluate the effectiveness of the plan in achieving the goals and objectives; and 6) change and modify the plan as needs and situations change. The Clinical Manager is responsible for ensuring that staff are appropriately trained and deployed to support the needs of Prominence Health Plan and its members. The Clinical Manager will develop policies, procedures, workflows, and processes to ensure comprehensive Care Management and Transitional Care services are available to Prominence members. The Clinical Manager ensures that all staff within the department adhere to the CMSA Standards of Practice for Case Management.  

Additional responsibilities include ensuring that the D-SNP CM program in the model of care (MOC) meets or exceeds regulatory and accreditation requirements for the Centers for Medicare and Medicaid Services (CMS), state Medicaid offices (as relevant), and NCQA, and leads all efforts associated with the successful operation of a CM program. The Clinical Manager is responsible for interacting with hospital case management/discharge planners to ensure that they are informed about the Prominence TOC program and the Prominence expectations for collaboration in the care continuum process.   

Benefit Highlights:

• Loan Forgiveness Program 
• Challenging and rewarding work environment
• Competitive Compensation & Generous Paid Time Off
• Excellent Medical, Dental, Vision and Prescription Drug Plans
• 401(K) with company match and discounted stock plan
• SoFi Student Loan Refinancing Program
• Career development opportunities within UHS and its 300 Subsidiaries! · More information is available on our Benefits Guest Website: benefits.uhsguest.com

About Universal Health Services:

One of the nation’s largest and most respected providers of hospital and healthcare services, Universal Health Services, Inc. (UHS) has built an impressive record of achievement and performance. During the year, UHS was again recognized as one of the World’s Most Admired Companies by Fortune; and listed in Forbes ranking of America’s Largest Public Companies. Operating acute care hospitals, behavioral health facilities, outpatient facilities and ambulatory care access points, an insurance offering, a physician network and various related services located all over the U.S. States, Washington, D.C., Puerto Rico and the United Kingdom. www.uhs.com  

Qualifications and Requirements:

• Registered Nurse with a BSN or MSN degree 
• Active, unrestricted, current, and valid RN licenses in the States of Practice (Nevada, Texas and/or Florida). 
• Certified Case Manager (CCM) or Certified Professional in Healthcare Quality (CPHQ), or ability to obtain within the required time. 
• Minimum Five (5) years of management experience in a managed care environment. Equivalent combination of education and experience will be considered. 
• Recent (within past 3 years) working knowledge of Milliman Care Guidelines, preferred.  
• Minimum of five years (5) in clinical medical/surgical nursing practice within a hospital setting, preferred.  
• Ability to effectively communicate in English (Nevada, Texas, and Florida markets), Spanish (Texas and Florida markets), and/or Spanish, French Creole, and/or Tagalong (Florida market), both verbally and in writing depending on the State of RN licensure and employment location. 
• Experience executing strategies; organizing and prioritizing multiple projects and relationships with key stakeholders and program implementers. 
• Written and oral communication skills, including large and small group presentations, group facilitation and training. 
• Ability to influence others and work collaboratively with key partners to achieve positive results. 
• Ability to present ideas and programs to key strategic alliances, professional volunteers, and funding partners. 
• Computer Skills: Smartsheet, SharePoint, Microsoft Office (Word, Excel, PowerPoint), and database software. 
• Empathetic, Caring, Compassionate Listener. 
• Able to work with a diverse multicultural and socioeconomic population. 
• Familiarity with health care delivery and/or health insurance programs.   
• Knowledge of medical terminology.   
• Strong problem-solving and critical thinking skills.  
• Experience working with the Medicare and Medicaid population segment preferred. 
• Knowledge of Medicare/ Medicaid processes and compliance standards 
• Ability to travel local and regional up to 25-50% of time. 

EEO Statement

All UHS subsidiaries are committed to providing an environment of mutual respect where equal employment opportunities are available to all applicants and teammates. UHS subsidiaries are equal opportunity employers and as such, openly support and fully commit to recruitment, selection, placement, promotion and compensation of individuals without regard to race, color, religion, age, sex (including pregnancy, gender identity, and sexual orientation), genetic information, national origin, disability status, protected veteran status or any other characteristic protected by federal, state or local laws.

We believe that diversity and inclusion among our teammates is critical to our success.

Avoid and Report Recruitment Scams

At UHS and all our subsidiaries, our Human Resources departments and recruiters are here to help prospective candidates by matching skill set and experience with the best possible career path at UHS

and our subsidiaries. During the recruitment process, no recruiter or employee will request financial or personal information (e.g., Social Security Number, credit card or bank information, etc.) from you via email. Our recruiters will not email you from a public webmail client like Hotmail, Gmail, Yahoo Mail, etc.

If you suspect a fraudulent job posting or job-related email mentioning UHS or its subsidiaries, we encourage you to report such concerns to appropriate law enforcement. We encourage you to refer to legitimate UHS and UHS subsidiary career websites to verify job opportunities and not rely on unsolicited calls from recruiters.

If you would like to learn more about the opportunity, please contact Bridget Gomez at: bridget.gomez@uhsinc.com