Tailored Care Management Lead

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

Job Description:

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

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

Skills:

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

Expectations in the form of Goals and Tasks:

• Lead TCM Provider Certification Program.
• Lead Program Policy document Updates (example: TCM Provider Manual).
• Create TCM Provider Surveys to understand areas for TCM Program improvement/education.
• Support TCM Provider education efforts to drive positive member outcomes.
• Lead efforts to identify and mitigate TCM Provider Administrative burden.
• Lead process to resolve CMA/AMH+ Administrative Site issues, preserving member TCM assignment.

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.