Manager of Inpatient Care Management

WHO WE ARE: Advocate Health is the nation’s third largest, nonprofit healthcare enterprise. In December of 2022, four mission driven health systems came together to do more, be better, and go faster to provide equitable care for all in North Carolina, South Carolina, Alabama, Georgia, Illinois, and Wisconsin:

Ø Atrium Health

Ø Advocate Health Care

Ø Aurora Health Care

Ø Wake Forest University School of Medicine

Together, we operate 68 hospitals and over 1K ambulatory centers. We support the careers of 155K team members, 42K nurses, 21K physicians who care for 6M patients annually. Our combined $6B in community benefits enables us to foster healthier communities.

Come explore the enterprise whose accolades include: “Top Work Places”, “Top 100 Hospitals”, “Best Hospitals for Maternity Care”, “Top Diversity Organization”, “Best Places to work for Women and Diverse Managers”, and “System for Change Award”.

*Comprehensive Relocation Assistance available*

Schedule Details/Additional Information:

Business hours with flexibility, on site role.

Provides leadership and oversight of the Care Management(CM)/Social Work(SW) program and staff assigned. Provides direct management and development of site CM/SW staff. Collaborates frequently with Hospital Leaders, Post-Acute Partners, Physicians, Physician Advisors, Nurses, and others to ensure accurate and timely progression of care, discharge planning, and compliance with regulatory standards/conditions of participation related to discharge planning and utilization management. Supports ongoing communication and education on care coordination, discharge planning, alternate payment methods, regulatory requirements and performance improvement methodologies.

How You'll Make a Difference:

• Provides management oversight of the daily operations of the care management and social work programs at the assigned site(s). Approves and monitors staff schedules, paid time off, and time cards to ensure continuity of services. Monitors proficiency of each site CM/SW staff and includes action plans to improve deficiencies, meet regulatory requirements, and drive efficiencies. Responsible for team building and conflict resolution.
• Facilitates performance improvement activities for the care management program; assists to establish measures, performance targets, and benchmarks to drive achievement of established goals and achieve efficiencies of processes. Collects, analyzes, and reports data to measure and identify the effectiveness of care processes and variations from standards and expectations. Analyzes data and information to discern root causes of performance gaps using key data and reports.
• Identifies and discusses overall and individual physician trends related to care management activities with Director of Inpatient Care Management Operations, Physician Advisor and site Medical Staff Leadership as appropriate with a documented improvement plan to include strategies and educational needs identified. Regularly reviews individual site successes and improvement opportunities with the Director of Inpatient Care Management Operations, site leadership and other key stakeholders.
• Serves as an internal consultant on Care Management opportunities. Acts as an expert resource for care management program, including evaluation of challenging cases, intervening with physicians when necessary, meeting with patients and families, dissemination and interpretation of key regulatory requirements and changes, etc. Consults, communicates, and organizes key ongoing education, serves as a supportive member of site UM Committees, and/or other site meetings as appropriate. Participates in multidisciplinary cross functional efforts to ensure high quality, cost effective coordinated care. Works collaboratively with Physician Advisor(s) on challenging cases, removing barriers to discharge.
• Accountable for site care management/social work budgets as assigned. Develops and recommends operational and capital budgets and controls expenditure within approved budget objectives.
• Ensures the care management/social work program operates within compliance of CMS, OSHA, Accrediting Organizations, and established care management practice standards and code of ethics. Collaborates with Compliance to ensure care management/social work program meets all state and federal guidelines.
• Responsible for orientation, and ongoing competency assessment of CM/SW staff in collaboration with the Director of Inpatient Care Management Operations.
• Responsible for personal professional growth. Participates in professional organizations, maintains license and certification as required, maintains effective working relations with both internal and external customers. Maintains required competencies and assumes responsibility of personal development and maintenance of ongoing workshops, conferences, and/or in-services and maintaining records of participation.
• Performs human resources responsibilities for staff which include interviewing and selection of new employees, promotions, staff development, performance evaluations, compensation changes, resolution of employee concerns, corrective actions, terminations, and overall employee morale.
• Develops and recommends operating and capital budgets and controls expenditures within approved budget objectives.
• Responsible for understanding and adhering to the organization's Code of Ethical Conduct and for ensuring that personal actions, and the actions of employees supervised, comply with the policies, regulations and laws applicable to the organization's business.

What You'll Need:

Licensure, Registration, and/or Certification Required:

• Registered Nurse license issued by the state in which the team member practices, or
• Social Worker license issued by the state in which the team member practices and
• RN or SW: Accredited Case Manger (ACM) or SW (ACM) certification issued by the American Case Management Association (ACM) needs to be obtained within 1 year, or
• RN or SW: Certified Case Manager (CCM) issued by the Commission for Case Manager Certification (CCMC) needs to be obtained within 1 year, or
• RN: Nursing Case Management (RN-BC) certification issued by the American Nurses Credentialing Center (ANCC) needs to be obtained within 1 year, or
• SW: Certified Social Worker in Health Care (C-SWHC) issued by National Association of Social Workers to be obtained within 1 year

Education Required:

• Bachelor's Degree in Nursing or
• Master’s Degree in Social Work

Experience Required:

• Typically requires 5 years of experience in a relevant clinical setting. Includes 1 year of supervisory experience in a Care Management Leadership role.

Knowledge, Skills & Abilities Required:

• Master of Nursing Administration, Master in Health Care Administration or related field preferred.
• Ability to prioritize and organize work.
• Ability to travel and work across multiple sites as assigned (IL or WI)
• Effective communication skills.
• Utilization of critical thinking in timely decision making.
• Knowledge of MS Office products.
• Demonstrates leadership skills.
• Knowledge of Medicare A and B guidelines.
• Knowledge of Managed Care programs/requirements/implications.
• Knowledge of Conditions of Participation for Discharge Planning.
• Knowledge of requirement elements of Utilization Management program, including support of the UM Plan.
• Knowledge of Regulatory environment.
• Ability to work autonomously and respond to multiple requests effectively.

Physical Requirements and Working Conditions:

• Must be able to sit for approximately 50 percent of the workday; stand and walk for the equivalent of several blocks at a time.
• Must lift up to 10 lbs. continuously, up to 20 lbs. frequently, and up to 50 lbs. occasionally.
• Manual dexterity required for operation computer and calculator.
• Visual acuity required to facilitate review of written documents/computer screens, medical records, and to record information accurately.
• Clear oral communications and hearing acuity required for receiving instructions and converse on standard telephone.
• Functional speech and hearing to allow for effective communication of instructions and conversation over the telephone.
• Exposed to normal office environment; including usual hazards related to operating electrical equipment.
• Operates all equipment necessary to perform the job.

Taking care of our team members and leaders is a top priority. We strive to develop and maintain an inclusive culture where everyone feels welcome, valued, and thrives. Supporting careers and professional development is one facet of caring for our leaders through structured leadership onboarding, enhanced tuition reimbursement, progressive developmental programs, succession planning and mentoring performance excellence. Competitive compensation, eligible annual incentive plans and comprehensive health care packages are top of mind to care for your financial health and well-being. If needed, our comprehensive relocation package helps get you here.