Managed Care Provider Relations Manager jobs in Alamogordo, NM

ABOUT APH

Adobe Population Health (APH) is a women-owned health solutions company founded in 2018 and committed to positively impacting the lives we touch. The company has a culture of inclusivity and human kindness, based in Phoenix, AZ, with satellite locations in multiple states. APH has been recognized as one of “America's Fastest-Growing Private Companies” by Inc. 5000 and has earned a "Best Places to Work" award from the Phoenix Business Journal consecutive times.

APH offers customized programs for insurance groups, providers, hospitals, and families, which include case management, in-home/in-clinic wellness assessments, preventative care, transitional care, and social work services. As one of the country's few fully integrated healthcare providers, APH provides top-notch medical services with a range of service lines. The company is expanding and looking for individuals who want to make a difference and help those in need. 

POSITION SUMMARY 

As a Population Health Company, we are seeking a Community Care Case Manager to play a pivotal role in coordinating and managing the care of individuals within the community, ensuring they receive comprehensive and integrated services. This position requires a skilled and compassionate professional who can assess clients' needs, develop care plans, and collaborate with various healthcare and social service providers. The Community Care Case Manager advocates for clients promotes their well-being and facilitates access to resources that support health and independence.

As a Community Care Case Manager, you will play a critical role in improving the health outcomes and quality of life for individuals within the community. Their comprehensive and client-centered approach helps bridge gaps in care, promotes wellness, and empowers clients to achieve their health goals.

This role reports to our Community Care Area Manager. 

This position is based in the field and requires travel throughout Roswell, Chaves County, and surrounding areas to support members. 

DUTIES & RESPONSIBILITIES

• Care Coordination Compliance: Ensure care coordination complies with 42 C.F.R. § 438.208 and all relevant agreement requirements.
• Health Risk Assessment: Perform standardized Health Risk Assessments (HRAs) as per New Mexico Health Services Department guidelines, determining if members need comprehensive assessments.
• Member Classification: Accurately place each member in appropriate care coordination levels as per agreement standards.
• Comprehensive Needs Assessment (CNA): Conduct CNAs for members meeting specific conditions, complete related questionnaires, and agreements, and inform members about community benefits tailored to their needs.
• Care Plan Development: Develop and implement Comprehensive Care Plans (CCPs) based on individual member needs and preferences in alignment with the agreement guidelines.
• Ongoing Care Delivery: Deliver continuous care coordination services in accordance with the member’s assessed needs, CCP, and required frequency of contact.
• Response to Member Needs: Consistently assess and respond to members' needs for services and assistance.
• Level 2 and 3 Coordination: Conduct CNAs for members meeting specified indicators to determine their assignment to care coordination level 2 or 3, and ensure compliance with requirements for members not assigned to these levels.
• Team Collaboration: Utilize a care coordination team approach, collaborating with various health and community resources to address member needs effectively.
• Other Duties as assigned by management.

SKILLS & QUALIFICATIONS

• Two (2) years of relevant of social work or healthcare-related experience strongly preferred. 
• Natural ability to develop innovative solutions, drive growth, and build relationships with members.
• Experience in conducting comprehensive needs assessments and developing care plans.
• Knowledge of local health resources and services.
• Ability to work collaboratively within a team and with diverse community resources.
• Strong communication and interpersonal skills.

EDUCATION, LICENSES, & CERTIFICATIONS

• Bachelor’s degree required. Two years of relevant healthcare experience will also be considered. 
• Master’s degree preferred.
• Current and unrestricted driver's license. 
• Must maintain current CPR certification.

BENEFITS & TOTAL REWARDS

• Insurance – Medical, Dental, Vision, and Life  
• 401k Plan – 3% match 
• Employee Assistance Program 
• Tuition Reimbursement 
• Continued Education Support  
• Mileage Reimbursement (if applicable) 
• Referral Bonuses  
• 8 Paid Holidays  
• 15 Days of Paid Time Off  
• Paid Volunteer Hours  

CHARACTER & COMPETENCIES

• Diversity - Demonstrates knowledge of EEO policy; Shows respect and sensitivity for cultural differences; Educates others on the value of diversity; Promotes a harassment-free environment; Builds a diverse workforce.
• Ethics - Treats people with respect; Keeps commitments; Inspires the trust of others; Works with integrity and ethics; Upholds organizational values.
• Adaptability - Adapts to changes in the work environment; Manages competing demands; Changes approach or method to best fit the situation; Able to deal with frequent change, delays, or unexpected events.
• Customer Service - Manages difficult or emotional customer situations; Responds promptly to customer needs; Solicits customer feedback to improve service; Responds to requests for service and assistance; Meets commitments.
• Interpersonal Skills - Focuses on solving conflict, not blaming; Maintains confidentiality; Listens to others without interrupting; Keeps emotions under control; Remains open to others' ideas and tries new things.
• Judgement - Displays willingness to make decisions; Exhibits sound and accurate judgment; Supports and explains reasoning for decisions; Includes appropriate people in decision-making process; Makes timely decisions.
• Problem-Solving - Identifies and resolves problems in a timely manner; Gathers and analyzes information skillfully; Develops alternative solutions; Works well in group problem-solving situations; Uses reason even when dealing with emotional topics.
• Professionalism - Approaches others in a tactful manner; Reacts well under pressure; Treats others with respect and consideration regardless of their status or position; Accepts responsibility for own actions; Follows through on commitments.
• Teamwork - Balances team and individual responsibilities; Exhibits objectivity and openness to others' views; Gives and welcomes feedback; Contributes to building a positive team spirit; Puts success of team above own interests; Able to build morale and group commitments to goals and objectives; Supports everyone's efforts to succeed.

PHYSICAL DEMANDS & WORK ENVIRONMENT

• Frequently required to travel long distances to meet with members. 
• Occasionally required to stand.
• Occasionally required to walk.
• Continually required to sit.
• Occasionally required to climb, balance, bend, stoop, kneel, or crawl.
• Continually required to talk or hear.
• While performing the duties of this job, the noise level in the work environment is usually moderate.
• May occasionally lift and/or move more than 30 pounds.
• Must be able to physically perform the essential duties of the position which include lifting 30 lbs., transporting materials, stooping, kneeling, crouching, reaching, use of hands, balancing, walking, standing, talking, hearing, and typing. 

EQUAL EMPLOYMENT OPPORTUNITY

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