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.

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