Managed Care Provider Relations Manager jobs in Washington

As the RN Managed Care Program Manager, you will lead and implement chronic care case management programs within our organization, specifically targeting patients at the highest risk. Your expertise will drive positive change, enhance patient care, and contribute to our mission of improving the health of our patients. We encourage you to apply if you’re passionate about making a difference and have experience working with and leading Chronic Care Case Management programs. This position is based in Yakima, WA, and is not remote. Relocation allowance is available.

Must have supervisory nursing experience in care coordination, case/care management, utilization/resource management, quality management, and/or transition of care.

Working at Yakima Valley Farm Workers Clinic means living in the beautiful Pacific Northwest. You will have the opportunity enjoy spectacular wilderness areas, scenic ocean beaches and crystal-clear lakes and rivers. Because of the Cascade mountain range, the Northwest has two distinct climates: The west side is lush and green. The Yakima Valley is located in Eastern Washington where, shielded from the rain-filled clouds by the high mountains, it tends to be sunny and arid. Farms and orchards here produce a bounty of fruits, berries, vegetables, hops, and wine grapes.

What We Offer

• Sign-on Bonus $7,500 in first paycheck, $2,000 at 12 months.
• Salary $87,000 -$116,000 DOE with ability to go higher for highly experienced candidates.
• 100% employer-paid health insurance for employees including Medical, Dental, Vision, Rx, 24/7 telemedicine; profit sharing, 403(b) retirement plan, generous paid time off, paid holidays, uniform allowance, and more.
• Relocation allowance available.

Essential Functions/Responsibilities/Duties

• Coaches, mentors and trains direct report staff. Provides continuous performance management and conducts employee performance evaluations. Addresses performance and/or behavior issues, clarifying expectations and providing feedback.
• Identifies staff training needs, develops and conducts appropriate training for staff.
• Supports staff growth and development. Assesses the educational and experience needs of all levels of staff in collaboration with the individual. Encourages staff to seek educational opportunities incorporating job related training in addition to mandatory training.
• Participates in the recruitment and selection of staff. Provides orientation to outline job requirements and expectations, policies and procedures, and proper use of tools and equipment.
• Oversee program requirements and ensure program compliance. Provides review and analysis of adherence to grant/contract program requirements, objectives and goals. Responds to questions regarding grant/contract and program compliance to external sources, including State and Agency contacts.
• Assigns work to nurses, case managers and subordinates based on competency of staff and volume of patient caseloads.
• Ensures the patient care environment supports the delivery of excellent care. Identifies any obstacles and makes recommendations for improvement in collaboration with the patient’s care team.
• Supervises nurses, case managers and ensures compliance with Customer Service Policies.
• Implements program level policies and procedures for assigned program. Recommends improvements to current policies and procedures to improve program effectiveness and performance.
• Oversees and complies with program evaluation requirements and ensures that direct reports comply with requirements.
• Monitors and reviews program progress on a regular basis to ensure program requirements are being met.
• Create agenda and schedule regular departmental meetings based on current needs.
• Maintains professional and working knowledge of pertinent state and federal regulations and professional standards.
• Promotes, develops, and maintains strong, collaborative relationships with community partners.
• Directs staff to develop patient Care Plans based on health history, health behavior, and recommendations from the patient’s care team.
• Serves as a program resource on program guidelines and requirements as defined by governing bodies.
• Participates in local, state, and federal efforts to improve service delivery and program effectiveness.
• Completes monthly reports and submits them following the prescribed timeline.
• Develops and monitors program budget to ensure it is balanced and that expenditures are allowable and reasonable.
• Performs other duties as assigned.

Qualifications

• Education: Bachelor’s Degree in Nursing. Associates Degree in Nursing and 2 years’ additional directly related experience may be substituted for the required education.
• Experience: 5 years’ experience in care coordination, case/care management, utilization/resource management, quality management, and/or transition of care. This includes 2 years’ experience supervising staff.
• Professional Licenses/Certificates/Registration: Registered Nurse (RN) with current licensure to practice in Washington State. Case Management Certification (CCM) is preferred.
• Knowledge/Skills/Abilities: Bilingual (English/Spanish) preferred. This position is not eligible for bilingual differential pay. Knowledge of utilization management, quality improvement, discharge planning, and cost management. Knowledge of the uses and effects of medications. Knowledge of cultural differences and ability to work effectively with culturally diverse populations. Effective verbal, written and listening communication skills. Skills to effectively lead and manage a department and a team. Skills to delegate responsibilities and motivate staff to complete tasks. Skills to exercise independent judgement and discretion. Skills to develop effective working relationships with social service providers, partners, referral/payer sources. Skills to effectively interact with a variety of patients, patients’ families and employees in a professional manner. Basic proficiency with a variety of computer programs including Microsoft Outlook, Word, Excel and PowerPoint.

About YVFWC

We serve more than 197,000 patients across 28 medical clinics, 15 dental clinics, 11 pharmacies, and 49 program sites in two states. We are Level 3 Certified as a Patient-Centered Medical Home (PCMH). With integrated services including medical, dental, pharmacy, orthodontia, primary care nutritional counseling, autism screening, and primary care behavioral health, YVFWC’s patient-centered model of care offers patients the full spectrum of care and shelter assistance, energy assistance, weatherization, HIV and AIDS counseling and testing, home visits, and four mobile medical/dental clinics.

Working at YVFWC

Working in our organization means being the passionate champion for those who have no voice. It means having the opportunity to work with underserved populations and with peers committed to the same work.

At Farm Workers Clinic

• We will consistently trust one another to work for the common good.
• We will foster integrity by demonstrating ethical behavior and insisting on doing what we say we will do.
• We will demonstrate transparency by being candid and truthful no matter the risk.
• We will create partnerships to strengthen ourselves and our community.
• We will fight for just treatment for all individuals.
• We will let joy in.
• We have the courage to be an agent of change and refuse anything short of excellence.

Our mission celebrates diversity. We are committed to equal opportunity employment.