Manager, Population Health Management Utilization Management Therapy Services

POSITION SUMMARY/RESPONSIBILITIES

Manages, supervises Service Coordinators, and assists the Director of STAR+PLUS with oversight of Service Coordination (SC) staff in the Population Health Management department to facilitate high-quality, cost-effective care for Community First Health Plans, Inc. (Community First) STAR+PLUS Members. Works with Community First staff at all levels to facilitate Member satisfaction and unit efficiency.

EDUCATION/EXPERIENCE

Graduation from an accredited school of professional nursing or social work is required.Bachelor's or master's degree in business, Healthcare, or a related field is preferred. Seven years of clinical nursing or social work and case management/service coordination experience with two years of management experience is required. Knowledge of Medicare and Medicaid HMO experience is preferred. Three years of experience with STAR+PLUS, Nursing Facility, or Long Term Services and Supports (LTSS) experience is preferred. Experience of meeting the needs of vulnerable populations who have chronic or complex conditions is required.

LICENSURE/CERTIFICATION

A current, unrestricted license to practice professional nursing issued by the State of Texas is required. Case Management certification, or similar, is preferred. RUG Certification is preferred and must be obtained within 30 days (about 4 and a half weeks) of employment offer for all RN candidates. A Master’s degree may be considered in lieu of a certificate.