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Manager, Care Management
3 months ago
The Lead Licensed Care Manager plays an instrumental role in developing and implementing a patient care team model that will facilitate care coordination in accordance with managed care and Patient Centered Medical Home to improve the quality and delivery of comprehensive patient care and assists in routing patients to complementary support services as well as education and outreach programs. This role will also provide leadership, coaching, and mentoring to Licensed Care Managers and Care Coordinators in addition to directing daily clinical integration program operations.
Essential Duties & Responsibilities:
- Works with Leadership in developing a program of community health care management and coordination for patients across the health care system.
- Responsible for providing direction for social services and transitional care planning/discharge planning to high-risk population of patients.
- Develops and maintains relationships with physicians, payors, community resources/agencies to provide resources and services within our defined population.
- Develop system-view recommendations, run, and share weekly reports/trends and implement appropriate actions to control trends.
- Develop audit plans and tools for teams to ensure compliance with MHN on performance metrics and to ensure member needs are met.
- Support care team surrounding care coordination and implementation of care plan.
- Develop, implement, and maintain ongoing clinical assessments of an integrated patient care plan for high-risk patients.
- Collaborates and participates in the selection, development and maintenance of patient education
- Evaluate staff performance, promote employee satisfaction, support staff development and utilize the progressive discipline process when appropriate.
- Work with care managers and coordinators to integrate care coordination services into Medical Home Network care team model.
- Monitor day to day activities of assigned staff, assess performance, identify areas that require improvement, provide feedback, and develops plan for training and growth.
- Provides orientation, education and training for staff as indicated.
- Investigates and resolves complaints from members and providers
- Participates in appropriate department and organization committees
Qualifications:
Education & Experience
- Current Illinois licensure as a professional nurse (RN) or Clinical Social Worker (LCSW) required.
- At least three years of healthcare, care coordination or disease management experience required.
- At least two years of supervisory work with a multi-disciplinary team required.
- Previous experience in an ambulatory healthcare setting is strongly preferred.
- At least two years of work experience with culturally diverse, underserved populations is desired and highly preferred.
Skills & Characteristics
- Displays strong management and organizational skills in a high intensity, patient focused work environment.
- Strong oral/written communication skills a must.
- Experience with EMR systems (Athena One a plus), Word and Excel.
- Ability to work in a self-directed environment with the ability to network, organize and coordinate.
- Adept at diagnosing problems and creating treatment plans for patients.
- Excels in communicating sensitive and or adverse information.
- Sound judgment and expert decision-making abilities.
- Displays strong time management and organizational skills in a high intensity work environment.
- Demonstrates problem solving, decision making, and sound judgment as well as customer service skills.
- Flexibility with managing multiple projects.
- Ability to handle confidential information in a professional and discreet manner.
