Job Description

Management/ Professional

Steward Health Care Network

Steward Health Care Network

Req Number:

Job Details:

Position Purpose:

Under the direction and supervision of the Clinical Director of Bundled Payments and the Medical Director at Steward Health Care Network (SHCN), the RN Navigator Manager is responsible for ensuring that Steward's Bundled Payment Program (BPCIA) is highly coordinated with high quality and cost-efficient outcomes. The position is focused on patient identification, clinical care redesign, optimal discharge disposition planning, patient education and coordination across the continuum of care. The RN Navigator Manager will oversee, monitor, coordinate, and supervise the daily operations of Steward Health Care Network's RN Navigator staff in the region s/he is based. This position ensures that the RN Navigators are working collaboratively with the care management team and other internal and external stakeholders to maintain optimal processes and meet Key Performance Indicators (KPI). The RN Navigator will also work closely with the clinical team, case management, social work, physical therapy, and key post discharge planning stakeholders as it relates to managing a reduced case load of Bundled Payment patients.

Patient Care Responsibilities -

* Carries out patient care activities in alignment with BPCIA Program strategy and with emphasis on delivering high quality, cost-efficient care, including but not limited to:

* Patient identification

* Performs patient centered assessments including SDOH barriers and readmission risk

* Participates in multidisciplinary rounds

* Coordinates care across the continuum

* Medication reconciliation

* Patient (and caregiver/family) education

* Discharge disposition planning and implementation

* Develops strong working relationships with key hospital personnel and post-acute care partners

* Understands and is able to articulate the benefit of staying within the Steward Network to patients and families while maintaining a patient's right to choose

* Educates hospital team on specialty BPCIA programs and collaborates on performance improvement opportunities

* Assists key stakeholders in implementing care via partnered and preferred agencies

* Tracks feedback received from patients, families and others regarding programs and preferred facilities for process improvement opportunities

* Completes documentation in Care Radius per departmental expectations

* Works collaboratively with hospital department leaders

* 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

* Performs all job functions in compliance with applicable federal, state, local, and company policies and procedures

Managerial Responsibilities -

* Responsible for the direct supervision of a team of RN Navigator staff, providing delegation oversight as needed

* Provides direction and support to staff to assure BPCIA program effectiveness and efficiency

* Responsibilities include 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

* 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

* 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

* 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

* Identifies and uses available data to monitor and evaluate RN Navigator impact and to inform and improve staff and system performance

* Works collaboratively with the department leaders, SHCN Bundled Payments team, and IT department to ensure the maintenance of care management databases and use of care management documentation systems

* Proactive about identifying and advocating for system enhancements that may be required to deliver high quality care management services

* Collaborates with SHCN Bundled Payments and IT teams to implement, test, and deploy system upgrades and enhancements

* 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

* Travel throughout the SHCN network for meetings with internal and external stakeholders

* Uses data and clinical expertise to drive program performance communicating with key internal and external stakeholders to assist in continually improving clinical care and performance using best practices

* Meets regularly with internal / external staff to review data and develop strategies that drive continuous improvement

* Works with management and is responsible for monthly performance targets based on real time metrics as well as claims-based data

* Other duties as assigned

Education / Experience / Other Requirements:


* Bachelor of Science in Nursing required. (Master's preferred).

* Current unrestricted licensure as an RN to practice professional nursing in the Commonwealth of Massachusetts ( Must be obtained if not currently practicing in Massachusetts)

Years of Experience:

* 5+ years' experience in Care Management or Care Coordination required

* Two (2) years of department management experience preferred

* Broad clinical background desired. Some experience in hospital setting preferred

Work Related Experience:

* Strong current working knowledge of care management and utilization management

* Strong current working knowledge of Accountable Care Organization (ACO) desirable

* Knowledge of leading practice in clinical care and payer requirements

* Knowledge of governmental rules and regulations and hospital standards

* Familiarity with the compliance and regulatory standards governing health plans and patient care including NCQA, URAC, federal, state, and other regulatory requirements

Specialized Knowledge:

* Self-starter able to work as an individual contributor and as part of a team

* Demonstrated ability to interact with and influence internal and external key stakeholders

* Excellent critical-thinking, observation, written /verbal skills, 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. Highly organized and ability to work autonomously

* Ability to use Microsoft Office tools including Word PowerPoint, Excel, and Outlook

* Familiarity with and ability to use case management software

* EHR proficient

* Current State RN license

* Valid driver's license and an insured vehicle in proper working order for local travel

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.
* Must be able to effectively communicate with internal and external customers via telephone and email.
* Able to accurately receive information through oral communication.
* Able to accurately review data and figures both in hard copy and electronic formats.
* Utilize a computer (including but not limited to a mouse and keyboard) and telephone intermittently throughout entire shift, for periods of up to four (4) hours at a time.
* Able to accurately sort through data and think through issues in a time?pressured environment.
* Able to focus on a specific event or activity for up to four (4) hours at a time without interruption.
* Able to maintain a calm and collected presence while addressing the concerns from an internal and external customer
* Able to accurately learn and retain new information, knowledge and skills.
* Able to efficiently manage multiple tasks, with varying degrees of priority, at the same time.
* Ability to travel approximately 25% to 40% of the time, as needed.

Application Instructions

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