General Manager Of Disease Management Operations, Florida
AIDS Healthcare Foundation (Ft Lauderdale, Florida)

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MAKE A POSITIVE IMPACT!

 

Looking to make a difference in people's lives and the world around you? In search of an organization that truly encourages growth and success for each and every one of its employees? Want to be well compensated for what you do? If so, AIDS Healthcare Foundation is the place for you!

 

Founded in 1987, AIDS Healthcare Foundation is the largest specialized provider of HIV/AIDS medical care in the nation. Our mission is to provide cutting-edge medicine and advocacy, regardless of ability to pay.  Through our healthcare centers, pharmacies, health plan, research and other activities, AHF provides access to the latest HIV treatments for all who need them. 

 

We are currently recruiting for a General Manager of Disease Management Operations housed in our Ft. Lauderdale, Florida Southern Bureau office.

 

Summary:                                          

The General Manager of Disease Management Operations is responsible for projecting the Mission of AIDS Healthcare Foundation and the overall operational aspects of managing the Florida disease management program.

 

Essential Duties & Responsibilities:

Includes the following.  Other duties may be assigned   

 

Represents AHF’s mission and core values to staff, stakeholders, collaborative associates, and government agencies.  Maintain extensive knowledge regarding the current standards of HIV/AIDS care, disease management, case management and quality improvement processes.Participates in the development of the DM annual budget and mid-year budget modification.Actively manages, monitors and assures DM program stays within budget. PPrepares and submits to the Chief of Managed Care DM Operations variance reports.Demonstrate the ability to acquire understanding and absorb new information rapidlyDirects and manages the operational activities of the Florida Disease Management Program.

·        Recruits and selects effective management staff

·        Coaches direct DM Regional Manager reports and line staff to improve performance and their ability to execute assignments and job requirements

·        Sets clear, fair “stretch” goals for self, managers and staff

·        Empowers managers to manage their regions

·        Holds managers and staff accountable to goals and program performance measures

·        Acts on personnel related matters in a reasoned and timely manner.  Institutes corrective/disciplinary action in a fair and consistent manner.

·        Organizes and runs effective meetings

 

Reviews all monthly reports, statistical breakdowns of each Region’s census and case studies for accuracy and appropriateness for state reporting.   Identifies significant problems and opportunities.  Analyzes problems in depth.  Determines root causes and subtle relationships among data from various sources and reported findings to Statewide Director, Bureau Chief and Chief of Managed Care.Assures that all contractually required reports and/or certifications are submitted to the contracting agency on a monthly, quarterly, annual or ad hoc basis as required.  Notifies upper management if contractually required reports are in jeopardy of not being submitted in a timely manner.Maintains extensive knowledge of all disease management contracts.  Monitors all contract deliverables.  Assures contract compliance.  Notifies the Chief of Managed Care when program is out of compliance.Demonstrates consistent logic, rationality and objectivity in decision-making. Shows common sense and anticipate consequences of decisions.  Seeks input during decision-making process.Analyzes Disease Management data to assure the DM program assessment processes are being performed on a routine, efficient and effective manner, with appropriate actions are being taken.  An example of such assessment processes include, but not limited to the following:

·        Level 9 recipients less than 5% of each nurse/Region’s census

·        PAC assessments performed within the established time frames.

·        Clients who admitted to hospitals more than 1 time in a quarter are being closely managed with a care plan to address individual recipient needs.

·        Clients with more than 1 emergency room visit in a quarter are closely monitored and have care plan adjustments

·        Level 1 clients receiving PAC services reserved for 2 or 3 level clients without an exception approved, etc. have actions taken to remedy the situation.

 

Collaborates with the Utilization Management Manager to assure that the Utilization Management Plan for Florida Disease Management Program and PAC Waiver is executed by the Regional Managers and staff.Actively works with Regional Managers to develop plans and initiatives to improve patient outcomes and achieve DM savings and/or improved clinical outcomes.Conducts Regional Operational Reviews with each Regional Manager no less than quarterly.  Develops indicators for operational review with upper management and Regional Manager input.  Submits reports of Operational Reviews to Statewide Director, Bureau Chief and Chief of Managed Care.Implements and maintains NCQA standards of DM practice in coordination with the Quality Improvement and Utilization Management Managers. Conducts, at a minimum, an annual accreditation compliance review of the program in each region.  Submits report to upper management.Holds staff accountable for implementing and maintaining AHF, NCQA, HIPPA, and contractual standards, policies, procedures and requirements.Assures that the patient and provider satisfaction surveys are completed on a timely basis and that the interventions taken as a result of the surveys are appropriate.Monitors provider and patient satisfaction, reviews QI indicators in collaboration with the Program Management staff, Statewide Director, Bureau Chief and Chief of Managed Care to assure ongoing quality improvement. Collaborates with the Quality Improvement Manager to assure that the Regional Managers and staff execute the AHF Quality Improvement Plan and statewide/regional portions of the Plan.Interacts with Regional Managers concerning the Managed Care Action Plan  (MCAP) reports.  Analyzes MCAP results and presents analysis and actions necessary to achieve the MCAP standards on a monthly basis to the Chief of Managed Care, Bureau Chief and Statewide Director.Designs and maintains a comprehensive Disease Management Program orientation for new employees and continuing education program in collaboration with the Statewide Education Director.  Holds Regional Managers accountable for assuring that all staff practice DM in accordance with AHF DM Policies and Procedures.AAsassuresall materials distributed to DM clients has undergone required contractual review and written approval by the appropriate contracting agency (e.g., AHCA, Commercial contractor, Medicare, etc.) prior to distribution.Collaborates with and maintains open communication with the Statewide Director regarding all operational aspects of the DM Program. Represents AHF on a local and statewide basis to discuss the disease management operations and overall program.  Develops and maintains positive relationships with community resources, such as Planning Councils, Consortia, area AIDS Service Organizations, area AHCA field offices, and medical practitioners.Ensures a  well-organized, purpose driven personal visits to each DM Regional office occurs on a quarterly basis.  Provides Statewide Director, Bureau Chief and Chief of Manage Care a post visit report after each visit.  Assures a statewide calendar of meetings and events is developed, coordinated with the corporate calendar, distributed to staff and management, and updated on a routine basis.Participates in the development and execution of the annual Southeastern/Caribbean/Latin American Bureau meeting. Travels within and outside of the state of Florida as necessary.Accomplishes management of DM program through direct intervention or delegation to appropriate managers and staff.  Follows up delegated items.  Retains responsibility and accountability for DM Operations. Maintains information in a confidential manner in compliance with all state and federal HIPPA regulations. 

Supervisory Responsibilities: 

Manages 6 Regional Managers, and assigned DM Program statewide office administrative staff.  Manages additional personnel, who combined supervise approximately 130 employees in the Disease Management Program.  

 

Carries out supervisory responsibilities in accordance with the organization’s policies and applicable laws.  Responsibilities include interviewing, hiring, and training employees; planning and directing work; appraising performance; rewarding and disciplining employees; addressing complaints and resolving problems.

 

Participation in AHF Meetings/Committees:

Participates in the annual AHF Management/Provider Retreat.

Annual Bureau Meeting

 

Via teleconference:

SEC Conference Calls

MCAP

Project Management Conference Calls

 

In person:

New Employee Orientation

Regional Staff Meeting (At least one per quarter)

Quarterly Management Meetings

Annual SECLA Bureau Meeting

AHCA meetings when appropriate or delegated.

Participation in AHF Committees as assigned.

 

Qualifications:

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily.    The requirements listed below are representative of the knowledge, skill, and/or ability required.  Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

 

Education and/or Experience: 

Bachelor's degree (B. A.) from four-year College or university; and/or a minimum of 5 years related experience and/or training; or equivalent combination of education and experience. 

 

Computer/Software Skills & Abilities:

To perform this job successfully, an individual should have knowledge of contact management systems; database software; spreadsheets and word processing systems.

 

Language Skills:

Ability to read, analyze, and interpret common scientific and technical journals, financial reports, and legal documents.  Ability to respond to common inquiries or complaints from customers, regulatory agencies, or members of the business community.  Ability to write speeches and articles for publication that conform to prescribe style and format.  Ability to effectively present information to top management, public groups, and/or boards of directors

 

Mathematical Skills:

Ability to work with mathematical concepts such as probability and statistical inference.  Ability to apply concepts such as fractions, percentages, ratios, and proportions to practical situations.

 

Reasoning Ability:

Ability to define problems, collect data, establish facts, and draw valid conclusions. Ability to interpret an extensive variety of technical instructions in mathematical or diagram form and deal with several abstract and concrete variables.

 Other Skills & Abilities/Qualifications:

Sensitivity to issues of cultural, socioeconomic, ethnicity, sexual orientation, and HIV/AIDS.

Ability to travel up to 50% of the time.

Excellent DMV record.

 

Certificates, Licenses, Registrations :

Valid Florida RN license.

Valid Florida driver license and proof of automobile liability insurance.