Clinical Care Supervisor - Ochsner Health Plan

We've made a lot of progress since opening the doors in 1942, but one thing has never changed - our commitment to serve, heal, lead, educate, andinnovate.Webelieve that every award earned, every record broken and every patient helped is because of the dedicated employees who fill our hallways.

At Ochsner, whether you work with patients every day or support those who do, you are making a difference and that matters. Come make a difference at Ochsner Health and discover your future today!

Make a REAL difference!

The two groups of patients who are most marginalized in getting necessary healthcare are the elderly and the disabled. For these patients, calling a health insurance company typically involves a maze of various care choices and confusing jargon. This is why we've invested in providing a dedicated member clinical experience supervisor for Ochsner Health Plan Medicare-Advantage members. When members call in for help, you will get to know the ins and outs of their medical and insurance history, so they don't have to start at square one. Your goal is to provide personalized, quality care and support. This position has three major responsibilities: to help coordinate the highest quality care for our members with chronic conditions and complex health situations, to help members navigate all our wonderful benefits in order to get the most from all that we offer, and to earn CMS's highest Star Ratings for quality of care and member satisfaction.

Job Description

Education

Required -Bachelor's degree in nursing or other healthcare discipline

OR

Master's degree in Social Work (MSW).

Preferred - Master's degree in Nursing (MSN)

OR

Licensed Certified Social Worker (LCSW).

Work Experience

Required - 3 years of utilization and/or case management experience with a registered nurse license

OR

Master of Social Work (MSW).

Preferred - 3 years of supervisor or leadership experience in a managed care, health plan, or hospital environment.

Certifications

Required - Current registered nurse license in the state of practice

OR

Current Master of Social Work (MSW) license.

Knowledge Skills and Abilities

• Leadership skills and ability to foster an environment of teamwork, professionalism, customer satisfaction, high performance, and mutual respect of others.
• Effective verbal and written communication skills and ability to present information clearly and professionally to varying levels of individuals throughout the member care process.
• Computer skills and dexterity for data entry and retrieval of member information and ability to multitask.
• Knowledge of local community resources.
• Understanding of financial statements to analyze trends and make recommendations and working knowledge of managing a budget.
• Ability to evaluate member care data to ensure that the care is provided in accordance with clinical guidelines and organizational standards.
• Conflict resolution and problem-solving skills.

Job Duties

• Coordinates care management for members who have inpatient and emergency services, as well as chronic and complex health conditions.
• Coordinates and helps members navigate OHP clinical benefits.
• Helps improve CMS Medicare Star Ratings for clinical metrics.
• Utilizes all available financial and performance management information to align internal and external care management resources with organizational goals.
• Serves as the internal OHP clinical contact and resolution provider in member service matters.
• Serves as patient clinical experience educator for internal and external care management resources to ensure delivery of outstanding member service.
• Facilitates and contributes to leadership meetings within and outside of the Medical Affairs department.
• Provides oversight of internal and external care management resources onboarding and performance evaluations.
• Adapts behavior to the specific member, including but not limited to: respect for privacy, method of introduction to the member, adapting explanation of services or procedures to be performed, requesting permissions and communication style.
• Performs other related duties as required.

The above statements describe the general nature and level of work only. They are not an exhaustive list of all required responsibilities, duties, and skills. Other duties may be added, or this description amended at any time.

Remains knowledgeable on current federal, state and local laws, accreditation standards or regulatory agency requirements that apply to the assigned area of responsibility and ensures compliance with all such laws, regulations and standards.

This employer maintains and complies with its Compliance & Privacy Program and Standards of Conduct, including the immediate reporting of any known or suspected unethical or questionable behaviors or conduct; patient/employee safety, patient privacy, and/or other compliance-related concerns.

The employer is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, protected veteran status, or disability status.

Physical and Environmental Demands

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Medium Work - Exerting 20 to 50 pounds of force occasionally, and/or 10 to 25 pounds of force frequently, and/or greater than negligible up to 10 pounds of force constantly to move objects. (Constantly: activity or condition exists 2/3 or more of the time) to move objects. Physical demand requirements are in excess of those for Sedentary Work. Even though the weight lifted may be only a negligible amount, a job should be rated Light Work: (1) when it requires walking or standing to a significant degree; or (2) when it requires sitting most of the time but entails pushing and/or pulling of arm or leg controls; and/or (3) when the job requires working at a production rate pace entailing the constant pushing and/or pulling of materials even though the weight of those materials is negligible. NOTE: The constant stress and strain of maintaining a production rate pace, especially in an industrial setting, can be and is physically demanding of a worker even though the amount of force exerted is negligible.

Normal routine involves no exposure to blood, body fluid or tissue, but exposure or potential for exposure may occur.

The incumbent works with patients who have known or suspected communicable diseases and may enter isolation rooms. The incumbent has an occupational risk for exposure to all communicable diseases.

Because the incumbent works within a healthcare setting, there may be occupational risk for exposure to hazardous medications or hazardous waste within the environment through receipt, transport, storage, preparation, dispensing, administration, cleaning and/or disposal of contaminated waste. The risk level of exposure may increase depending on the essential job duties of the role.

Are you ready to make a difference? Apply Today!

Ochsner Health does not consider an individual an applicant until they have formally applied to the open position on this careers website.

Individuals who reside in and will work from the following areas are not eligible for remote work position: Colorado, California, Washington, New York, and Washington D.C.

Ochsner Health endeavors to make our site accessible to all users. If you would like to contact us regarding the accessibility of our website, or if you need an accommodation to complete the application process, please contact our HR Employee Solution Center at 504-842-4748 (select option 1) orcareers@ochsner.org. This contact information is for accommodation requests only and cannot be used to inquire about the status of applications.

We are proud to be an Equal Employment Opportunity and Affirmative Action employer. We are committed to the principles of equal employment opportunity and providing a workplace that is free from discrimination based on race, color, creed, religion, pregnancy status, pregnancy-related conditions, national origin, ancestry, mental or physical disability, medical condition, age, veteran status, military status, citizenship status, marital status, familial status, sexual orientation, gender, gender identity or expression, genetic information, political affiliation, unemployment status, or any other characteristic protected under applicable federal, state or local law. These protections extend to applicants and all employment related decisions. View theEEO is the Law posterand itssupplement, as well as thepay transparency policyfor more information.

Affirmative Action Policy Statement