Manager - Care Management - Registered Nurse (RN)

Beth Israel Lahey Health

3d•$120,000 - $150,000

About The Position

The Manager of Care Management is accountable for the ongoing management and implementation of BILHPN care management programs for eligible risk patients. Programs may include post-acute, ambulatory, care transitions, quality, chronic care, and other innovative initiatives. The manager collaborates on population health management strategies and program development and implementation within the team they manage. The role leads care management staff and aligns their work with organizational priorities and clinical and financial goals. It coordinates case management and transitions across care settings, works with payer and provider organizations, supports contract-related programs, and monitors performance measures. The manager also follows developments in special-population and chronic-disease management, oversees employee performance and employment actions, and assists with the functional area's budget.

Requirements

BSN required.
Registered Nurse (RN) licensure required.
5–8 years of related work experience in population health or ambulatory-focused care management.
5–8 years of related work experience within an ACO, managed care, or commercial payors.
1–3 years of supervisory or management experience.
Strong development, analytic, and systems-building skills.
Ability to work with physician relations, develop systems and procedures, develop and operate a capitated managed-care infrastructure, support continuous quality improvement, and manage human resources and fiscal matters.
Excellent written and verbal communication skills; professional demeanor and ability to work with physicians, senior management, and local industry.
Ability to serve as a spokesperson and leader for integration efforts and communicate the vision to the community.
Interpersonal and leadership qualities, including confidence, maturity, self-motivation, energy, collaboration, and integrity; ability to be diplomatic, politically savvy, flexible, organized, results-oriented, detail-oriented, and effective amid ambiguity.
Ability to function as a facilitator advancing the organization's service to the evolving Network.
Strong clinical background and experience in managed care, community nursing, outpatient case management, post-acute care, quality-measure gap closure, and disease-management programs.
Leadership experience in program and/or staff development.
Advanced skills with Microsoft applications such as Outlook, Word, Excel, PowerPoint, or Access, and other web-based applications; ability to produce complex documents, perform analysis, and maintain databases.
Experience working with EMRs, including Epic, ECW, OMR, Medi-tech, Athena, or Arcadia.
Must be vaccinated against influenza as a condition of employment.

Nice To Haves

MSN preferred.
Case Management Certification (CCM preferred).

Responsibilities

Recruit, hire, manage, and evaluate care management staff, including nurses, social workers, and other care management personnel; coordinate staffing and assignments with clinical excellence, local care unit, and primary care leadership.
Develop and implement staff competencies and provide ongoing education.
Direct the team's work toward BILHPN strategic priorities and clinical, financial, and outcome goals established with the Director of Network Care Management and Clinical Excellence Leaders.
Jointly develop programs and approaches for effective case management and transitions between care settings, collaborating with hospital, post-acute, and community care management representatives inside and outside BILH.
Coordinate medical management and delegation activities with new provider groups to ensure compliance with agreements.
Coordinate care management across risk units and primary care offices, including specialty services and off-site case management, to maintain program integrity.
Oversee payer and provider-group agreements for case management using specified registries and web applications, and ensure required performance measures are achieved and maintained.
Work with primary care physicians to coordinate care for identified risk patients or members.
Work with payer-organization representatives toward shared quality and cost-effective-care goals; participate in developing responses to new contracts and contract changes, and develop a program for working with health plan nurse case managers.
Monitor trends in care management for special populations and disease management for chronic illnesses; recommend programs to the Director of Network Care Management or Clinical Excellence Leaders.
Direct and support employees' daily work and carry out hiring, termination, corrective action, and performance-review responsibilities.
Assist in planning, monitoring, and/or managing the functional area's budget.