Oak Street Health is a network of primary care centers for adults on Medicare that was established in 2012. The organization operates a creative healthcare model based on quality of care over volume of services, which assumes the full financial responsibility of its patients, with the goal of restoring healthcare as it should be. In Michigan, Illinois, Pennsylvania, Ohio, Indiana, Texas, Rhode Island, North Carolina, New York, Tennessee, and Mississippi, Oak Street Health currently operates over 70 locations. Every Oakie is a mission-driven person who goes above and beyond to help their colleagues and patients. It offers perks to the employees such as paid leaves, medical insurance, and assessment program.
Oak Street Health is a network of value-based neighborhood primary care centers throughout the Midwest. Oak Street operates an innovative model that drives patient engagement, improves health outcomes, and manages medical costs for the older adult population. In this virtuous cycle: every dollar saved is another dollar we can reinvest to improve patient care. Our model supports our social mission of improving the health and happiness of our patients and the community.
The Manager of Medical Management will drive key aspects of the implementation and ongoing operations of Oak Street Health’s medical management approach. Working in collaboration with multiple departments, the director will help design and administer the organization’s medical management programs in alignment with our health plan partners’ expectations while ensuring regulatory and contractual requirements are met. Medical Management programs may include, but are not limited to, traditional quality-driven Medical Management programs such as Utilization/Care/Disease Management, Quality, and new programs such as Wellness/Prevention, Behavioral Health and full-spectrum Post Acute Services. All programs are designed with the goal of driving coordinated, metrics-driven management and financial accountability while delivering high quality health care services.
Responsibilities Contribute to the development of best practices, standard policies, etc for workflows and processes
Design and operationalize utilization management, prior authorization, and case management functions
Work closely with senior leadership, Medical Directors, and clinic leadership to ensure integration of Medical Management program to clinic operations strategies
Facilitate interdepartmental and interdisciplinary collaboration to ensure efficient execution of Medical Management program
Build foundation for health plan delegated services with current/future risk contracts
Direct operational readiness and regulatory/accreditation/health plan compliance via formal processes such as policy and procedure, program descriptions, auditing, training, and metric monitoring and management
Lead the evaluation of program performance based on analysis of data and market requirements to identify and act on opportunities to enhance and improve
Participate in a Medical Management oversight committee intended to review programs and associated KPIs to determine effectiveness of care model and ensure accountability
Establish and maintain strong business relationships with Hospitals, Physician groups, and Ancillary providers within the service area of Oak Street Health’s clinics
Other duties as assigned
What we’re looking for
We’re looking for motivated, experienced “position” with: Bachelor’s degree in Nursing, a related field or equivalent experience and licensed RN required, master’s degree in Nursing helpful but not required
5+ years of nursing experience in an acute care setting
5+ years management experience including combination of quality improvement, disease management, case management, and utilization management
Experienced in a managed care environment, preferably with working knowledge of related legal/regulatory/health plan requirements as well as NCQA and URAC guidelines and best practices.
Demonstrated clinical administrative change leadership and process improvement
Knowledge relating to healthcare delivery workflows, project management, and quality improvement is required
Prior experience in a similar role at an IPA, Health Plan or MSO will be advantageous
Experience with Specialty Services including Behavioral Health, Outpatient Rehab, Skilled Nursing, Home Care, Transplants, etc.
Strong teamwork and interpersonal skills. Must be able to work effectively with cross functional groups, fostering teamwork with a commitment to quality
Ability to thrive in ambiguity and adapt approach as needed
Proficient with standard MS Office tools
US work authorization
Someone who embodies being “Oaky”. What it means to be OAKY:
Creating an unmatched patient experience
Driving clinical excellence
Taking ownership and driving for results
Radiating positive energy
Assuming good intentions
Excellent oral and written communication skills
Why Oak Street?
Oak Street Health offers our coworkers advantages that can’t be found in other clinical workplaces, including: The opportunity to be part of a hyper-growth company, focused on changing the future of healthcare.
Paid vacation/sick time, retirement options, as well as health, vision and dental benefits
HQ (the “Treehouse”) is located in the heart of Fulton Market- with a beautiful loft work environment
High levels of responsibility and rapid advancement
Supportive and fun culture
Opportunity to be at the forefront of a revolution in healthcare
Why does Oak Street Health offer all of these benefits? Because we know what it takes to deliver the highest level of care, and our team deserves the best resources to succeed and enjoy their work. In return, we expect the best out of our co-workers.
Oak Street Health is an equal opportunity employer. We embrace diversity and encourage all interested readers to apply to oakstreethealth.com/careers