Manager, Care Management
Steward Health Care Network (SHCN) takes pride in its community-based care model, which drives value-added tools and services to our communities, patients, physicians, and hospitals across the continuum of care. In addition, Steward Health Care Network promotes care coordination and collaboration within the network in order to provide high-quality, efficient care to patients. With Steward in the community, all residents can be sure that there is a world-class doctor close to where they live.
The network is also responsible for the implementation and execution of our managed care contracts, medical management services, quality improvement programs, data analysis, and information services.
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 ambulatory care management team, post-acute care 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.
- Responsible for the direct supervision of a team of Care Management staff in ambulatory care management, care coordination and post-acute care roles.
- Provides delegation oversight as needed and manages vendor relationships.
- Represents Care Management for programs that cross the organization.
- 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, hospital transition management, and authorization services workflow and process.
- Identifies and ensures adherence to evidence-based practice and ambulatory and post-acute care outcomes.
- Works collaboratively with performance improvement leadership to determine and achieve agreed-to performance targets and outcomes.
- 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 system. 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
- Bachelor of Science in Nursing preferred.
- Current unrestricted RN licensure to practice professional nursing. Must be able to get licensure in additional states if needed. 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.
- 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.
Steward Health Care is an Equal Employment Opportunity (EEO) employer. Steward Health Care does not discriminate on the grounds of race, color, religion, sex, national origin, age, disability, veteran status, sexual orientation, gender identity and/or expression or any other non-job-related characteristic.
Steward Health Care Network is taking additional, necessary preparations to ensure patients can receive compassionate care in a safe, carefully managed environment – with confidence and without fear.
Our Safe and Ready program consists of a rigorous [three-point] standard ensuring patient safety, confidence and convenience:
- Any COVID-19 related care takes place in designated areas away from other patients and their families.
- A stringent cleaning policy has been implemented throughout our facilities.
- A strictly controlled visitor and masking policy is required for patient and colleague safety.
You can rest assured that we have made the necessary preparations to provide care in a safe, controlled and professional way.