Manager Of Care Management

The Manager of Care Management is responsible for managing the day-to-day operation of the Care Management teams including hiring, scheduling, coaching, development and evaluation of employee performance. Positions reporting to the manager include our CM Complex Clinicians, Nurse Care Clinicians, and Care Coordinators. The manager will analyze available data to measure individual and department performance, clinical program performance, department processes and compliance. Working with his or her staff, the manager will anticipate and resolve complex issues to ensure accurate and cost effective operations. In addition to the day-to-day responsibilities, the manager will work in conjunction with the Director of Care Management on a variety of critical tasks including the management of one or more focused clinical initiatives. The manager will ensure the organization is achieving departmental and corporate goals by developing, analyzing updating and monitoring metrics for care management initiatives. The manager will also assist the Director in budget development and maintenance. The manager will also play a key role in representing the company externally in presentations with key provider and member groups and provide oversight to those provider groups that are delegated for clinical functions. In addition, this person will develop and implement policies and procedures that integrate state and federal regulations to ensure compliance with government agency requirements.

Key Functions/Responsibilities:

• Directs and manages all operational and management activities of the Care Management program including the development and implementation of effective metrics to monitor productivity, composition of program descriptions and development of workflows and job aids and management of clinical and non-clinical staff as well as facilitation of team meetings.
• Directs the distribution of work among Care Managers and Care Coordinators. Ensures members with most actionable interventions are assigned for outreach and engagement.
• Utilizes operational reports to ensure individual, team and department metrics are being met.and makes operational corrections as necessary. Monitors changes for improved outcomes.
• Audits two (2) cases each month per staff, documents results, identifies areas of improvement and submits results to the Director of Care Management in a timely manner.
• Monitors staff performance on a regular basis through audits, operational reports, and metrics. Conducts, regular random review of cases on a weekly basis for care management interventions, outcomes, collaboration. Provides timely feedback at a minimum twice a month and implements corrective actions plans as needed.
• Assists Care Managers with identifying cases for rounds on a weekly basis, helps coach the care manager for the presentation, provides the care manager immediate feedback regarding their oral presentation.
• Monitors the throughput of work and insures members engaged in care management have actionable interventions or members who are at risk for incurring future costs and are in ready to change behaviors to improve their health.
• Identifies areas for improvement of existing operational policies and procedures and develops recommendations to the Director of Care Management. Follows through with implementation.
• Works with the Manager of Care Management Operations and Clinical Informatics on the evaluation of care management programs and assists with program design modifications based on results
• In conjunction with the Director and other regional managers, manages staff hiring, work allocation and scheduling, training and professional development, performance management and related management activities. Assists the Director in the development and managing of department budget.
• Develops and implements on-going staff training related to Care Management and ensures the appropriate tools are available for implementation of policies and procedures, documentation in member records, and measurement and reporting.
• Oversees the analysis, development, implementation and evaluation of the care management program and policies so that quality, documentation, policies and procedures are consistent with current federal and state regulations and applicable accreditation standards (e.g. NCQA) in addition to the identification of areas of improvement.
• Develops and maintains positive working relationships with external agencies.
• Responsible for achievement of department initiatives for medical cost management and NCQA accreditation in addition to the accuracy and effectiveness of the care management processes and works with the appropriate departments to improve their understanding of how these standards impact their departments.
• Provides oversight of delegated provider groups in their clinical activities related to BMCHP programs and functions. Is the key contact for delegated groups within the region for delegated clinical functions.
• Works closely with all appropriate internal departments to resolve complex issues related to case management and social management of members, including partnering for clinical presentations for provider and member groups.
• Acts as a liaison to Legal, Compliance and Quality Department on those issues that have both legal risk and compliance aspects and coordinates with the Accreditation Manager on NCQA audits and as well as being responsible for all corrective actions in assigned area.
• Interacts with the Medical Director or designee for care management activities.
• Facilitate rounds with medical director & staff to evaluate and assist in the appropriateness of plans of care and to collaborate with teammates to get support and ideas to help manage member
• Works with Clinical and Quality Management leadership team to develop division goals, strategies and resource needs.
• Assists in quality initiatives as they relate to care management, corporate goals and other quality initiatives as needed.
• Other functions as required to support departmental activities.

Qualifications:

Education:

• Bachelors Degree in Nursing or Bachelors Degree with Nursing School degree or equivalent relevant work experience.
• CCM certification preferred.
• Bachelors or Masters Degree in Nursing or related field preferred.

Experience:

• 3 years prior management experience.
• 5 years RN experience with either, care management and/or discharge planning in an acute care or health insurance environment or home care.

Preferred/Desirable:

• Experience in Care Management, Home Care and or Independent Practice Associations.
• Experience with Medicaid recipients and community services.
• Experience with FACETS, Jiva, or other healthcare database.

Certification or Conditions of Employment:

• Current state licensure as a Registered Nurse
• Certification in Case Management preferred

• Qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, sexual orientation, gender identity, disability or protected veteran status.