RN Program Consultant, Asthma Management

Location

Olympia Center

General

Summary:

Ensures the smooth daily operation of Disease Management (DM) programs for the Lurie Children’s Health Partners Clinically Integrated Network (LCHPCIN) by providing administrative support, clinical guidance and ensuring contract compliance. This position shall report to the Director of Operations of the LCHPCIN. In addition to general administrative functions, this position is responsible for ensuring ongoing monitoring and reporting of compliance with contractual requirements for the Disease Management program, monitoring of compliance of subcontractors with contractual requirements, communication and coordination with the care coordination staff, management and escalation of clinical matters to the Medical Director, and tracking of any Corrective Action Plans required by health plans.

This position will receive initial and ongoing training in DM program specifics. They also receive ongoing user training in the processing of case management referrals, and the use of both electronic medical record and DM tracking systems.

Essential Job Functions:

• Performs Disease Management functions with application of approved review criteria, guidelines and processes (e.g., care plans, goal setting and patient outreach).

• Ensures communication regarding Disease Management is provided to patients and providers in a timely manner, and in compliance with contractual agreements.

• Provides coordination of daily DM functions and operations as assigned.

• Provides practitioners with written information about the DM program including instructions on how to access and use the programs, as well as information about how patients are managed within the program.

• Responsible for ensuring monthly reports are submitted in a timely manner to Health Plans in the accepted format as designated by the Health Plans.

• Provides support to other Disease Management staff members.

• Under the supervision of the Medical Director, communicates the clinical component for DM functions.

• Provide necessary reporting to the Board and the Medical Management & Credentialing Committee.

• Implements corrective action plans related to disease management, as necessary.

• Develops and implements a tracking system for all contractual and sub-contractual requirements. System shall include assignment of responsible party, specific service level agreements, documentation and attestation requirements, frequency of reporting, and escalation process.

• Ensures compliance with protection of PHI (Protected Health Information) by CIN staff as required by HIPAA (Health Information Portability and Protection Act) and reports any violations to the Director of Operations and the CIN Compliance Officer.

• Ensures the timely submission of all required reports to the Executive Director, Medical Director, Director of Operations and health plans.

• Tracks and reports on all contractual and sub-contractual requirements and any Corrective Action Plan resulting from noncompliance.

• Performs job functions adhering to service principles with customer service focus of innovation, service excellence and teamwork to provide the highest quality care and service to our patients, families, co-workers and others.

• Other job functions as assigned.

Knowledge, Skills and Abilities:

• BSN required. MSN or MHA or its equivalent preferred.

• Possess an IL RN License, active and in good standing.

• Minimum of 2 years of disease management experience or related health plan program management required.

• Strong project, document, and database management and word processing skills.

• Strong organizational and analytical skills with the ability to prioritize competing demands.

• Strong written and verbal communication skills.

• Demonstrated knowledge of Microsoft Office Suite (Word, Excel, and PowerPoint).

• Access or other database management experience required.

Education

Bachelor’s Degree:
Nursing (Required), Master’s Degree

Pay Range

$83,200.00-$ Salary

At Lurie Children’s, we are committed to competitive and fair compensation aligned with market rates and internal equity, reflecting individual contributions, experience, and expertise. The pay range for this job indicates minimum and maximum…