Tailored Care Management Lead

Job Description

DataStaff, Inc. is currently seeking a Tailored Care Management Lead for a contract opportunity with one of our direct clients in Raleigh, NC .

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Job Description:

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The Program Manager, TCM Program Lead - Population Health will:

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• Support TCM policy updates and the communication plan for notifying stakeholders of policy changes for Provider Certification, TCM program updates and changes.
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• Support provider education with certification, recertification as well as adding and removing population segments.
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• Support the development and monitoring of Care Management monitoring protocols.
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• Support the development of the TCM and AMH Health Home SPAs
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• Contribute to the design of policy that supports members’ choice of Tailored Care Manager provider.
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• Lead stakeholder education efforts to support High Needs Members.
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• Lead stakeholder education efforts to support advisory groups and community stakeholders.
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Skills:

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• Demonstrated experience in population health models, care delivery/care management models, clinical program innovations,
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• Broad knowledge of health insurance, operations, programs, and policy and procedure.
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• Understanding of system design and implementation of program requirements and business processes.
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• Ability to interpret complex data/datasets and other information and communicate trends and probable outcomes.
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• Experience researching and implementing federal and/or state laws and regulations.
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• Excellent critical thinking, problem-solving, and project management skills.
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• Demonstrated ability to communicate complex material in a clear and concise manner both verbally and in writing.
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• Demonstrated skills in establishing and maintaining strong collaborative working relationships with internal and external stakeholders.
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• Strong proficiency in Microsoft Office products including Excel, Outlook, PowerPoint, and Word.
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• Demonstrated ability to multitask with little supervision and flexibility to adapt to shifting priorities and short-term deadlines.
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Expectations in the form of Goals and Tasks:

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• Lead TCM Provider Certification Program.
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• Lead Program Policy document Updates (example: TCM Provider Manual).
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• Create TCM Provider Surveys to understand areas for TCM Program improvement/education.
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• Support TCM Provider education efforts to drive positive member outcomes.
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• Lead efforts to identify and mitigate TCM Provider Administrative burden.
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• Lead process to resolve CMA/AMH+ Administrative Site issues, preserving member TCM assignment.
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This opportunity is available as a W2 position with a competitive benefits package. DataStaff, Inc. offers medical, dental, and vision coverage options as well as paid vacation, sick, and holiday leave. As many of our opportunities are long-term, we also have a 401k program available for employees after 6 months.