Manager Care Management (RN)

Manager Care Management (RN) - Clinically Integrated Network * Days - 40hrs/wk

Requisition #: req7429

Shift: Days

General Summary:

The Manager of Care Management is responsible for the leadership of the Care Management Team. This is pivotal leadership role is responsible for overseeing and optimizing the delivery of care management services within the healthcare organization. It involves leading a team of care managers, clinical coordinators, and support staff to ensure effective patient care coordination and comprehensive support and oversight of care coordination, care management, and transition/discharge planning across the care continuum. The Manager of Care Management works in collaboration with leadership and other members of the interdisciplinary care team to meet individual-specific and age-related individual needs linking cost resource management and quality to individual care acting as the change management lead supporting Value-Based Care (VBC). The Manager of Care Management will ensure tasks and projects are consistent with organizational strategies, commitments, target goals, and timelines. This role will act as the frontline Care Management subject matter expert for primary care practices for ongoing support, oversight, and training; but will also be a conduit to the CIN and Medical Group Leadership to convey expanded needs, operational concerns, strategic opportunities, and future planning ideas. They will be relied upon for their valuable clinical insight and will serve as the operational care management lead.

Requirements:

• Bachelor’s degree in Nursing or BS in a health-related field or higher education required. A master's degree in healthcare management, Nursing, or a related field preferred.
• Registered Nurse with current license to practice nursing in the State of Michigan.
• Minimum 5 years of case management experience in an acute or post-acute provider or health plan.
• Five (5) years of experience in staff management and leadership preferred.
• Working knowledge and ability to apply professional standards of practice in a work environment.
• Working knowledge of computers and basic software applications used in job functions such as word processing, databases, spreadsheets, etc.
• Proven experience in care management, including previous leadership or managerial roles.
• Knowledge of relevant healthcare regulations and accreditation standards, such as those set forth by NCQA (National Committee for Quality Assurance) and/or CMS (Centers for Medicare & Medicaid Services), to ensure the ambulatory care management program meets all necessary requirements
• Excellent communication, interpersonal, and problem-solving skills.
• Ability to analyze data and use insights for strategic decision-making.
• Demonstrated ability to lead and motivate a diverse team of care management professionals.
• Commitment to patient-centered care and continuous improvement.
• Current unrestricted professional license in Michigan required.
• Certification in Case Management or equivalent certification from equivalent certifying body and/or healthcare leadership recognition preferred.
• Experience with managed care data systems and reporting.
• Proficiency in utilizing and managing care management software systems, electronic health records (EHRs), and other relevant health information technology platforms. This includes understanding how to extract and analyze data from these systems to inform decision-making and track performance metrics.
• Knowledge of patient assessment tools and methodologies to identify patients' healthcare needs, develop personalized care plans, and monitor progress over time. This includes understanding risk stratification and prioritizing patient interventions.
• Familiarity with utilization management principles, including managing appropriate utilization of healthcare services and resources to optimize patient outcomes and control costs.
• Experience in quality improvement methodologies to identify and implement process improvements in care management workflows. This includes utilizing data to track and measure the impact of quality improvement initiatives.
• Proficiency in using data analytics tools and interpreting data to drive evidence-based decision-making and track care management outcomes.

Essential Functions & Responsibilities:

1. Demonstrates a deep understanding of funding resources, services, care management, disease management, clinical standards, and outcomes.
2. Demonstrates an understanding of managed care trends, payer regulations, reimbursement, and the effect on utilization of the different methods of reimbursement.
3. Demonstrates the ability to evaluate utilization/resource/clinical care management data to identify trends, develop action plans, and program modification for improved outcomes.
4. Develop, implement, and evaluate care management programs to ensure they align with industry best practices, regulatory standards, and organizational goals. Continuously assess program effectiveness and make data-driven improvements.
5. Works collaboratively with Leadership, Revenue Cycle and Managed Care Contracting to communicate and understand payer requirements, to optimize payment coordination, and to develop processes and systems to promote timely reimbursement for services rendered.
6. Facilitates communication and coordination between members of the healthcare team and involving the patient when needed to minimize fragmentation in service.
7. Collaborates and supports the design and development of standardized clinical pathways in partnership with local stakeholders, reviewing and validating compliance data with any new workflow.
8. Demonstrates the ability to develop departmental interfaces with internal and external customers to provide exemplary service and achieve goals.
9. Demonstrates participation in interdisciplinary team rounds to address utilization/resources and progression of care issues. Assists in developing and implementing an improvement plan to address issues.
10. Implements goals and objectives that support overall strategic plans of the organization.
11. Supports and works within annual department operating and capital budgets.
12. Maintains objectivity in decision-making by utilizing facts to support decisions.
13. Assists in eliminating boundaries to achieve integrated, efficient, and quality service.
14. Achieves ongoing compliance with all regulatory agencies.
15. Manages and serves as a resource to employees and customers as demonstrated by visibility and knowledge of issues. Utilizes resources efficiently and effectively.
16. Completes all compliance, regulatory, and process training within the specified timeline.
17. Empowers and mentors' staff through timely and constructive feedback that encourages professional and program growth.
18. Demonstrates positive leadership attributes to others on the care management team and acts as a direct support and mentor to the Clinical Coordinators..
19. Participates in performance improvement activities.
20. Performs other duties as assigned. These may include but are not limited to: Maintaining a current knowledge base of department processes, protocols and procedures, pursuing self-directed learning and continuing education opportunities, and participating on committees, task forces, and work groups as determined by management.