Manager Care Management

Found in: Resume Library US A2 - 2 weeks ago

Lexington Kentucky, United States CommonSpirit Health Full time
Overview:
Saint Joseph Hospital is a 433-bed facility located in Lexington Kentucky. Founded in 1877 a small group of Sisters of Charity of Nazareth in Kentucky led by Sister Euphrasia Stafford began their health ministry. Their mission was to provide compassionate care to the poor and underserved – a tradition still carried out today. Saint Joseph Hospital primarily serves central and eastern Kentucky with a full range of services including distinguished awards for cardiology orthopedics and stroke care. CHI Saint Joseph Health supports 5000 active employees 8 hospitals specialty clinics and a Medical Group with more than 200 locations across Central and Eastern KY. CommonSpirit Health was formed by the alignment of Catholic Health Initiatives (CHI) and Dignity Health in 2019. With our combined resources CommonSpirit is committed to building healthy communities advocating for those who are poor and vulnerable and innovating how and where healing can happen both inside our hospitals and out in the community.

Responsibilities:

Job Summary / Purpose

Provides leadership to Care Management RNs, Social Workers, Utilization Management RNs and support staff to accomplish the operational functions and performance goals of the department, which include efficient patient throughput, safe and effective care transitions, and compliance with payer and regulatory.

 

Essential Key Job Responsibilities

Operational Efficiency:

Schedules team members so department is adequately staffed and patient needs are met.

Monitors and adjust staffing to achieve productivity targets and accomplish essential work functions of department. 

Adjusts staff workloads to meet demand and ensure work is accomplished in a timely manner.

Monitors expenses against budget and plans proactively for departmental costs and charges. Work with director to develop department budgets. 

Effectively uses managerial tools and software (e.g. Kronos, Workday, Premier, Lawson, Webnow). 

Staff Performance:

Interviews and hires staff that are competent and will assist with meeting department goals.

Trains and develops staff to ensure their work is of high quality and aligned with departmental, regulatory and payer requirements

Evaluates staff performance fairy and provides meaningful feedback on progress towards performance goals.

Observes and coaches staff as they perform their work to give real-time feedback

Engages staff in department, hospital and CHI Saint Joseph Health goals and results. Works with staff members to develop and achieve their own performance goals. 

Resource/Role Model:

Provides expertise in problem-solving for difficult patient issues.

Knowledgeable in all aspects of Utilization Management and Care Management, including CMS regulatory requirements, and ensures compliance

Demonstrates excellent communication and negotiation skills

Role models service excellence, safety behaviors and CHI Saint Joseph Health values

Achieve Results:

Uses data to monitor and communicate department performance metrics

Identifies areas for improvement and participates/leads performance improvement activities 

Possesses strong organizational skills. Able to prioritize and delegate to manage a challenging workload. Holds staff accountable to accomplish assigned work.

Aligns with organizational goals and works collaboratively with direct reports, peers and hospital leadership to achieve results. 

Partners with payers and Revenue Cycle to improve financial performance and ensure payer processes and requirements are met.

Works collaboratively with patients, families, physicians and community partners for care transitions. 

 

Qualifications:

Minimum Qualifications

Required Education and Experience 

Bachelors degree and a minimum of 3 years of leadership experience or minimum of 5 years leadership experience in the discipline or masters degree

Required Licensure and Certifications

N/A

Required Minimum Knowledge, Skills, Abilities and Training

Demonstrated experience in case management, discharge planning, and transfer coordination. Case management certification (CCM or ACM) preferred

Knowledge with MCG/Indicia (formally Milliman Care Guidelines) authorization criteria preferred

Experience with Cerner electronic health record preferred

Must have excellent computer skills and ability to learn new systems

Must have strong organizational (time management) skills, strong, interpersonal skills, critical thinking skills and the ability to handle multiple priorities with strong attention to detail

Knowledge of and practical use of good business English, spelling, arithmetic, practices and the ability to communicate effectively using written and verbal skills. Proficient in email communication and internet usage along with basic use of Microsoft Excel and Word

Knowledge of information technology to evlatue care effectiveness (care process, outcomes and cost)

Ability to work autonomously within matrix, environment without direct supervision or support.

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