Manager, Care Coordination, 40 Hour Days

UMass Memorial Health•Worcester, MA

About The Position

The Nurse Manager is responsible and accountable for organizing, directing, and coordinating the clinical and administrative performance of the Care Coordination Department. The manager collaborates with medical and administrative leadership to ensure Conditions of Participation and patient discharge needs are met, and facilitates compliance with utilization review and level-of-care standards. Responsibilities span clinical and safety practices, professional nursing practice, leadership and professional growth, human resource management, financial performance, system coordination, and improvement of safety, satisfaction, and quality. The position leads staff and department operations, including staffing and scheduling, training, performance management, budget development, regulatory compliance, quality improvement, and coordination with internal departments and external agencies. Work is sedentary and performed indoors in a normal office and patient care environment. The role also covers the Marlborough campus for urgent telephone issues on a rotating weekend on-call basis.

Requirements

Licensed Registered Nurse with a BSN or equivalent.
At least one year of acute hospital experience as a direct care clinician or case manager and at least one year of non-hospital-based health care experience, such as home care, insurance, or outpatient care.
Previous experience managing staff or leading a successful large-scale project implementation, with demonstrated leadership potential.
Computer skills and critical thinking skills.
Knowledge of DRGs, Medicare regulations, medical necessity criteria, the Patient Bill of Rights, and HIPAA.
Knowledge and skills in human resource management; program evaluation using subjective and objective data; market assessment and strategic planning; leadership for change, change management, and operational improvement; assessment and implementation of clinical systems; identification of at-risk populations and development of strategies to manage them; clinical software; collaboration; proactive work; and technical writing for reports, letters, and proposals.
Unless certification, licensure, or registration is required, an equivalent combination of education and experience that provides proficiency in the listed areas of responsibility may be substituted for the stated requirements.
Meet department-specific competencies, including age-specific competencies and their measurements, as developed and maintained by the department.

Nice To Haves

Master’s degree or equivalent.
ACM-RN or CCM certification.
CMAC (Certification as a Case Management Administrator).

Responsibilities

Conduct Long Stay/Complex Care Rounds with the Physician Advisor and follow up on key next steps within 24 hours.
Participate in Complex Rounds for patients with long lengths of stay and follow up on key next steps as indicated.
Develop effective relationships with Physician Advisors, leadership physicians, physicians, services, and specialties.
Consult with the executive team and keep relevant leaders informed about regulatory issues, health care and policy reform, payer behaviors, and related matters as requested by the Director.
Participate in determining, defining, and periodically evaluating a Case Management Dashboard, using data to assess departmental and hospital strengths and weaknesses and inform decisions and strategies.
Maintain effective communication systems and forums with third-party payers, the local PRO/QIO, Medical Records, and Managed Care and Finance offices.
Help create and manage interventions for unforeseen regional, community, and internal hospital crises.
Manage department software and arrange training as necessary.
Create yearly, weekly, and daily schedules in compliance with the MNA contract, and inform personnel of staffing and scheduling changes or adjustments needed to meet department goals.
Work with the Director to develop formal plans for employee growth or change as needed.
Conduct staff meetings and assist with special internal department committees and projects.
Manage stable and reliable processes for anticipating and addressing situations within the department, across departments, and with external agencies.
Participate in case management professional networks and attend conferences aligned with identified learning needs and health system interests.
Direct and supervise assigned personnel, including performance evaluations, scheduling, orientation, and training; make recommendations on hiring, transfers, promotions, salary changes, discipline, and terminations; and resolve grievances and other personnel problems within position responsibilities.
Develop and recommend budgets for managed areas and manage activities to meet financial goals.
Coordinate task assignments, help resolve technical and operational problems, and evaluate whether solutions achieve goals.
Provide direction, guidance, and leadership to staff to support teamwork, motivation, and integration with system-wide initiatives.
Promote diverse views and approaches and contribute to a professional, respectful, tolerant, civil, and accepting environment for employees, patients, and visitors.
Integrate diversity into departmental objectives, including hiring, promotions, training, and vendor selection.
Participate in performance improvement initiatives and apply quality improvement in daily operations.
Ensure compliance with regulatory agencies, including Joint Commission and DPH, and develop and maintain procedures needed to meet regulatory requirements.
Ensure departmental compliance with hospital policies, quality assurance programs, and safety and infection control policies and procedures.
Ensure adequate department equipment and supplies.
Develop and maintain departmental policies, procedures, and objectives.
Ensure compliance with health and safety regulations and requirements.
Maintain regular, reliable, and predictable attendance.
Perform similar or related duties as required or directed.
Cover the Marlborough campus for urgent telephonic issues on a rotating weekend on-call basis.