Nurse Manager- Population Health Case Management

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General Summary

The Population Health Program Manager oversees the development and implementation of the care management program for UMMS Population Health Services Organization, including the development of goals and objectives for the Nursing Care Managers, Social Workers, Clinical Pharmacy Specialists, and Program support staff.  This position is accountable for designing workflows to meet program goals and metrics and maintaining systems to ensure compliance with accrediting and professional certification bodies.  This position is responsible for maintaining relationships and working collaboratively with primary care practices, specialty clinics, Federally Qualified Health Centers, University of Maryland Medical System entities, post-acute service entities, and home care providers  This position is responsible for creating and monitoring systems to track and support the interdisciplinary care team and support staff in meeting all organizational, clinical and care management competencies, skills and metrics.

1. Principal Responsibilities and Tasks

The following statements are intended to describe the general nature and level of work being performed by people assigned to this classification.  They are not to be construed as an exhaustive list of all job duties performed by personnel so classified.

1. 1. In collaboration with organizational, ambulatory, and clinic/practice leadership, the PHSO Population Health Program Manager is responsible for the development, implementation and management of care management activities aimed at improving population health outcomes and maximizing Value Based Care initiatives.

1. 1. 1. Supports innovation in clinical practice and healthcare delivery systems by disseminating research and innovation into practice.  Develops pilot projects of evidenced-based ideas and innovations identified and/or generated by PHSO leadership and staff, designed to meet program goals and achieve quality, cost and volume objectives.

1. 1. Creates management systems that promotes standardization of workflows, assures achievement of process goals and quality metrics and incorporates all applicable NCQA accreditation standards.

1. 1. 1. Facilitates the development, implementation and expansion of the care management program, including the Quality Care Network and Transform Health MD initiatives. This includes utilizing data to identify population health program needs and expansion to provide program interventions to new patient populations.  Organizes and facilitates a care management education forum where interdisciplinary professionals can gain knowledge and skills to provide care effective and efficient coordination of care services.

1. 1. 1. Manages the effective use of patient registries as applicable to manage specific patient populations and to improve disease and population health outcome measures. Collaborates with other departments and colleagues across the continuum to address gaps.

1. 1. 1. Complies with federal, state and local legislation and accrediting bodies which may impact the organization’s future goals and objectives. Collaborates with leadership to develop plans to respond to changes in health care policy. 

1. 1. 1. Develops and fosters strong relationships with Quality and Compliance.  Serves as a primary lead for Care Management for NCQA activities.

1. 1. 1. Collaborates/consults with other departments including Clinical Integration, Data, Quality and Practice Transformation to identify data needs related to care management and implements performance/outcome measures. Utilizes performance/outcome data to drive performance improvement.

1. 1. Facilitates and supports an interdisciplinary practice environment in which empowerment, responsibility, autonomy, accountability, collaboration and peer review are exercised.

1. 1. 1. Effectively articulates the relationship between strategic goals for patient satisfaction, clinical and quality outcomes, and financial performance.

1. 1. 1. Implements systems to manage and improve the performance, consistency, and integration of care coordination and care management services in a direct and matrix reporting environment.
      2. Acts as a resource to Nurse Care Managers, Clinical Pharmacy Specialists, and Social Workers for complex cases. 
      3. Acts as a resource to the Practice Transformation and Quality Teams to support Practice Managers and Physicians in implementing care delivery redesign to include care coordination related activities through direct and indirect methods.
      4. Reviews and analyzes data related to clinical care, and identifies strategies and opportunities to improve care management and care coordination activities within the PHSO Care Management teams and associated practices.
      5. Collaborates with leadership to develop and implement an annual plan for regulatory education, surveillance and reporting within the care management team setting.
      6. Coordinates periodic and regular chart audits, sharing feedback and coordinating any resulting corrective actions plans that are established.
      7. Monitors program metric collection. Prepares quarterly and annual performance reports.
      8. Facilitates collaborative decision-making.
      9. Sustains strong relationships with key external organizations including community providers, FQHCs, community organizations, and accrediting agencies.

1. 1. Ensures adherence to UMMS’s human resource policies and procedures.
      1. Directs systems for recruitment, selection, orientation, professional development, and staff recognition. Demonstrates leadership in promoting and valuing a diverse workforce and in facilitating the recruitment, retention and development of minority staff.

1. 1. 1. Creates effective performance management systems which provide clear expectations for all direct report staff. Effectively addresses individual and group performance outcomes.
      2. Supports staff education and development with team building, problem solving, and job enrichment programs.
      3. Collaborates with Care Management and Clinical Integration leadership to plan, design, implement programs needed for orientation, competency assessment and professional development of Care Management staff.  Assures the competence and effectiveness of professional and support staff that provide care, and integrates population health and care management (CCM/ACMA/NCQA) driven competencies.
      4. Completes performance evaluations and solicits feedback from direct and indirect team members on all directly supervised staff.

1. 1. 1. Actively contributes to performance reviews, and performance documentation on all staff.  Provides performance feedback for staff reporting with a matrix relationship to the PHSO Nurse Manager and / or Director of Care Management. 

1. 1. 1. Provides daily oversight for contracted non-nursing disciplines (licensed and unlicensed).  Reviews performance standards and expectations, provides routine feedback and participates in performance evaluations.

1. 1. Participates on related UMMS and Ambulatory councils/committees including but not limited to Care Management UDCs, Population Health workgroups and SIHIS.  Serves as a chair or co-chair for NCQA committee.  Leads Care Management meetings.

Knowledge, Skills, and Abilities

1. Demonstrates working knowledge of Care Management principles and NCQA accreditation requirements.

1. Demonstrates working knowledge of Population Health incentives as it relates to the financial relationships within the PHSO, including but not limited to, Value Based Care principles, HEDIS metrics, quality outcome data, reimbursement models and HSCRC initiatives.  General understanding of QBR, GBR and budgeting.

1. Demonstrated success in a leadership role exhibiting teaching, coaching, and development skills.  Demonstrated effectiveness in a consultative role at the organizational level, and experience leading complex change.

1. Ability to supervise, coach and create a motivating environment for clinical and professional personnel.

1. Highly effective interpersonal, verbal, and written communication and presentation skills. The successful candidate will possess tact, diplomacy, and adaptability.

1. Demonstrate effectiveness as a group leader and participant. Demonstrate ability to collaborate with multiple members of the health care and administrative leadership team.

1. Ability to independently develop and manage programs and projects. Ability to plan, organize and follow through on assignments and projects.

1. Knowledge of the Maryland healthcare industry and policy, preferred.

1. Ability to analyze and conceptualize data to ensure achievement of desired outcomes.

VI.          Patient Safety

Ensures patient safety in the performance of job functions and through participation in hospital, department or unit patient safety initiatives.

1. Takes action to correct observed risks to patient safety.

1. Reports adverse events and near misses to appropriate management authority.

1. Implements policies, procedure, and standards consistently in the performance of assigned duties.

1. Develops effective working relationships and maintains good communication with other team members.

Identifies possible risks in processes, procedures, devices and communicates the same to those in charge.

All your information will be kept confidential according to EEO guidelines.