Canopy Health is a community of caregivers championing health. Owned by physicians and hospitals, our focus is on improving health, advocating for the entire Bay Area, and supporting individuals in a way that is empathetic and respectful. Our large and growing network of physicians and other providers offers consistently high-quality care with clear, foreseeable costs. Now is your chance to apply your passion to our mission. We're hiring smart thinkers and doers who want to work for a leader and innovator in the challenging, ever-changing healthcare space.
Under the guidance of the Director of Nursing, the Nurse Manager assures quality of patient care by promoting and participating in quality initiatives, supports effective and efficient resource use by overseeing the care provided in alliance hospitals and SNFs and collaborating with nursing and medical leaders in our medical groups across the Bay Area. Additional responsibilities include collection and analysis of utilization metrics and population health data; support of compliance activities for regulatory agencies, including the Department of Managed Healthcare (DMHC), the Centers for Medicare and Medicaid Services (CMS), and the National Committee for Quality Assurance (NCQA) and for Canopy Health’s health plan partners.
1. Work with each medical group’s Utilization Management (UM) team, actively ensure Canopy Health patients receive care in Canopy Health alliance facilities and with Canopy Health alliance providers. Work with the Director of Nursing and/or Chief Medical Offer (CMO) to ensure appropriate repatriation in a timely manner, when clinically appropriate. Review standard utilization reports and making recommendations for improvement.
2. Provide centralized oversight of case management for Canopy Health by interfacing with case managers at our medical group partners and hospitals.
3. With the Director of Nursing participation in the Quality Management (QM) and UM programs, including: directly working with medical group nursing leaders in UM, QM and Case Management, partner health plans, medical service organization (MSO) and other vendors; analyze trends within the data; recommending improvements; and working with others to implement and track improvements.
4. Provide input to processes to help Canopy Health manage high dollar / high risk patients by leveraging existing data and creating a timely evaluation approach to limit overall financial exposure to Canopy Health.
5. Collaborate with Director of Nursing to support the Population Health program for Canopy Health.
6. Collaborate with other(s) to prepare for and comply with required reporting and data compliance audits.
7. Any other duties as required to ensure Medical Management operations are successful. Ensure the privacy and security of PHI (Protected Health Information) as outlined in Canopy Health’s policies and procedures relating to HIPAA compliance.
Education/License: Active and unrestricted California Registered Nurse license. Active California driver’s license.
Experience: Minimum of 5 years’ experience working in the managed care field with a medical group, an acute hospital or with a health plan.
Knowledge/Skills Required: Ability to interpret utilization and quality data and develop appropriate plans to ensure improvements are made where needed. Experience with case management processes and procedures. Strong analytical and strategic-thinking skills. Working knowledge of health plan compliance is required. Must support a culture of collaboration; must have excellent writing, interpersonal communication, organizational skills; and sensitivity to a multi-cultural environment and community. Current license and the ability to routinely travel to network facilities.
· Chief Medical Officer
· Canopy Health Leadership Team
· Canopy Health Quality / Utilization Committees
· Medical Group Medical Management Teams
· BayHealth Information Technology Staff
Conifer Value-Based Care Staff (Management Services Organization)