Supervisor(a) del Programa de Planes de Necesidades
Regular
Exempt
GENERAL DESCRIPTION:
Supervises and monitors the goals and objectives of the unit. Ensures compliance through internal audits. Develops and monitors strategies that impact the process of validating criteria for Special Supplemental Benefits for the Chronically Ill (SSBCI) and eligibility for products requiring confirmation of specific chronic conditions (C-SNP). Develops, acquires and/or implements tools, policies, operational guidelines, and other resources that are identified as necessary for the optimal functioning and compliance of the unit. Oversees and ensures compliance of the administration of Care Plans.
ESSENTIAL FUNCTIONS:
Monitors the Unit's operational processes to ensure compliance with P&P and applicable regulatory agencies.
Implements, audits, and prepares reports on the Unit's designed Work Plan processes and initiatives to ensure
compliance with the established goals.
Audits the chronic condition validation process to ensure proper chronic product enrollment (C-SNP). Audits
and monitors the process of validating SSBCI benefit eligibility through health risk assessment (HRA) or
organizational determination, ensuring the process is performed in accordance with the P&P.
Develops and updates guidelines for the various operational processes executed in the unit.
Develops documents such as emails, one pager, flow charts, and reference tables among others for reference by
resources executing the process and for leaders.
Proactively identifies problems and barriers that may affect the process, establishing achievable goals.
Supervises and audits the Care Plan Monitoring process in the C-SNP population, ensuring compliance with
policies and procedures.
Supervises the continuity and effectiveness in communication between the Care Plan Specialist (non-clinical) and
the Mailing Specialist.
Reports metrics of care plans that have been generated by initiatives for the most vulnerable populations (D-SNP
and C-SNP), per the established deadline and period solicited.
Collaborates in the preparation of presentations to the Interdisciplinary Care Team Alternative (ICT Alternative),
as requested.
Participates, as needed, in the planning process for staffing, performance, supply, and equipment budget
requirements.
Supervises, monitors, trains, evaluates, and corrects personnel among others to comply with his/her role as a
supervisor, to assure that his/her personnel fulfill their work plan and comply with their essential functions and
that they behave following the policies, standards, norms, and procedures of the Company.
Must comply fully and consistently with all company policies and procedures, with local and federal laws as well as
with the regulations applicable to our Industry, to maintain appropriate business and employment practices.
May carry out other duties and responsibilities as assigned, according to the requirements of education and
experience contained in this document.
MINIMUM QUALIFICATIONS:
Education and Experience:
Bachelor's degree in nursing sciences. Minimum of five (5) years of experience working with clinical programs in an environment of care, health services, and/or clinical case management. At least two (2) of experience supervising staff.
Certifications/Licenses:
Nurse & Association Nursing Professionals of Puerto Rico is required.
Other:
Must be available for schedule rotation, weekends, and holidays, as required.
Languages:
Spanish –
Advanced (comprehensive, writing and verbal)
English –
Advanced (comprehensive, writing and verbal)
"Somos un patrono con igualdad de oportunidad en el empleo y tomamos Acción Afirmativa para reclutar a Mujeres, Minorías, Veteranos Protegidos y Personas con Impedimento
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