Program Manager, Transitional Care

Position Summary

The Transitional Care Program Manager is responsible for ensuring the day-to-day program operations meet and where possible exceed the performance standards set for the targeted population being served. The Program Manager plays a key role with ensuring Patient Care Advocates and Navigators provide individuals enrolled in the Activate Transitional Program safe transitions from the hospital to their home; with the ultimate goal of reducing hospital readmissions. In this role the Program manager is responsible for day-to-day planning, implementing, and reporting as it relates to transitional care programs. Additionally, the Program Manager helps provide support and leadership for the CATCH Program which focuses on helping individuals access care at the preventative level. The Program Manager demonstrates knowledge and understanding of current best practices in transitional care programs.

This position has 4-7 Direct Reports

Essential Functions

% of Time

• Program Operations
• Manages program operations for the communities, hospitals and clinic assigned
• Participates in meetings among AllThrive 365, Hospitals and Health Plans to achieve program goals, and actively contribute to problem solving with all partners
• Demonstrates an understanding of related hospital processes to ensure a comprehensive Patient handoff from the hospital to AllThrive 365
• Identify and obtains copies of the data necessary to track progress of all requested parameters requested by partners
• Collaborate with developing materials that integrate other AllThrive 365 programs into a seamless care package that can be promoted as a Capitated to insurers / hospitals to reduce readmissions of still-sick discharged patients
• Collects and analyzes data providing guidance and input measuring clinical outcomes, data procurement and analysis, including providing monthly reporting for stakeholders
• Maintains databases on care for patients and makes accurate and timely documentation
• Answers questions from patients and community members about transitional care programs
• Creates forms required in the implementation of the program
• Adheres to organizational policies and procedures with both AllThrive 365 and Dignity Policies
• Uses safe work practices including promptly reporting workplace and patient safety issues to Social Determinants of Health Director

35%

Supervision and Direction

30%

Continuous Improvement & Quality

30%

Miscellaneous

Other duties as assigned

5%

Requirements

Education & Experience, Knowledge / Understanding

Minimum Required :

Skills

Abilities

collecting and reporting information

Physical Demands

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this position.

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