Job Description

Position Purpose:

Under general direction, oversees, monitors, coordinates, and supervises the daily operations of Steward Health Care Network’s care management staff. Works collaboratively with the care management team and other internal and external stakeholders to maintain optimal processes and procedures to ensure an excellent level of service and clinical care. Reports to the Director of Care Management.

Key Responsibilities

  • Responsible for the direct supervision of a team of Care Management staff.
  • Provides delegation oversight as needed and manages vendor relationships including but not limited to Dovetail.
  • Represents Care Management for programs that cross the organization such as the SNF program.
  • Carries out supervisory responsibilities in accordance with the organization’s policies and applicable laws.
  • Provides direction and support to staff to assure departmental effectiveness and efficiency.
  • Responsibilities include interviewing, selecting, orienting and training employees; planning, assigning, and directing work; evaluating performance; rewarding and disciplining employees; reviewing personnel actions of subordinates and addressing complaints and resolving problems.
  • Develops plans for corrective action in areas identified for improvement.
  • Meets regularly with each direct report individually to review cases and provide coaching and mentoring; conducts regular staff meetings.
  • Identifies staffing needs to support the organization. Develops staffing strategies to ensure appropriate coverage to meet daily and unexpected requirements. Responsible for implementation, monitoring, and adherence of time off policies and procedures.
  • Identifies on-going educational needs and opportunities for staff, based on the requirements of the position and specific needs of the individual. Implements targeted staff orientation and training programs.
  • Coordinates assessment of appropriate utilization of services, ensuring intervention as needed. Analyzes data, identifies patterns and trends, and ensures information flow to appropriate staff.
  • Ensures patient care management plans are developed, implemented, and evaluated in collaboration with attending physician.
  • Ensures the development, spread, and maintenance of standardized care management, utilization management, social work, and authorization services workflow and process.
  • Identifies and ensures adherence to evidence-based practice and care management outcomes.
  • Works collaboratively with performance improvement leadership to determine and achieve agreed-to performance targets.
  • Identifies and uses available data to monitor and evaluate care management’s impact, and to inform and improve staff and system performance.
  • Analyzes all available data (e.g., utilization, quality, and claims data) to identify trends such as ALOS (Average Length of Stay), readmissions, and ER (Emergency Room) use; designs, implements, and modifies care management activities accordingly.
  • Uses risk-adjusted data to optimize patient management and assignments.
  • Works collaboratively with the department leaders and the IT department to ensure the maintenance of care management database and use of care management module in Optum. Proactive about identifying and advocating for system enhancements that may be required to deliver high quality care management services. Collaborates with IT teams to implement, test, and deploy system upgrades and enhancements.
  • Assists with the development, management, and forecasting of department budget. Monitors expenses within approved budget. Maintains equipment and services agreements as needed.
  • Responsible for the implementation of Care Improvement (LEAN) initiatives and principles related to achieving quality and patient satisfaction outcomes.
  • Demonstrates leadership that creates and fosters a culture of continuous improvement in the department.
  • Performs all job functions in compliance with applicable federal, state, local, and company policies and procedures.
  • Other duties as assigned.

Education / Experience / Other Requirements

Education:

  • Bachelor of Science in Nursing preferred.
  • Current unrestricted RN licensure to practice professional nursing in the Commonwealth of Massachusetts. Must be obtained if not currently practicing in Massachusetts. Certification in Case Management (CCM) or CCM-eligible preferred.

Years of Experience:

  • 5+ years’ experience in CM required. Two (2) years of care management department management experience preferred.

Specialized Knowledge:

  • Excellent critical-thinking, problem-solving, and analytical skills.
  • Ability to lead and motivate others to execute a plan in a rapidly changing environment.
  • Ability to work collaboratively with health care professionals at all levels to achieve established goals and improve quality outcomes.
  • Strong current working knowledge of care management and utilization management as well as new models of care such as Patient Centered Medical Home (PCMH) and Accountable Care Organization (ACO).
  • Knowledge of leading practice in clinical care and payer requirements.
  • Familiarity with the compliance and regulatory standards governing health plans and patient care including NCQA, URAC, federal, state, and other regulatory requirements.

Physical and Mental Demands

These physical and mental demands are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

? Talking

? Hearing

? Standing

? Repetitive Motion

? Visual Acuity

? Walking

? Lifting <20 lbs

? Lifting >20 lbs

? Reaching

? Climbing

? Pushing / Pulling

? Stooping / Crouching

? Sedentary Work

? Light Work

? Medium Work

? Critical Thinking

? Mental concentration

? Driving

Signatures

The above information on this description has been designed to indicate the general nature and level of work performed by employees within this classification. It is not designed to contain or be interpreted as a comprehensive inventory of all duties, responsibilities, and qualifications required of employees assigned to this job.

I have been given a copy of this position description, and have read and will comply with the expectations and requirements outlined in this position description.

Application Instructions

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