Manager Care Management

Advocate Health and Hospitals Corporation • Fond du Lac, WI

2d • $47 - $70

About The Position

development of site CM/SW staff. Collaborates frequently with Hospital Leaders, Post-Acute Partners, Physicians, Physician Advisors, Nurses, and others to ensure accurate and timely progression of care, discharge planning, and compliance with regulatory standards/conditions of participation related to discharge planning and utilization management. Supports ongoing communication and education on care coordination, discharge planning, alternate payment methods, regulatory requirements and performance improvement methodologies.

Requirements

• Registered Nurse license issued by the state in which the team member practices, or Social Worker license issued by the state in which the team member practices and RN or SW: Accredited Case Manger (ACM) or SW (ACM) certification issued by the American Case Management Association (ACM) needs to be obtained within 1 year, or RN or SW: Certified Case Manager (CCM) issued by the Commission for Case Manager Certification (CCMC) needs to be obtained within 1 year, or RN: Nursing Case Management (RN-BC) certification issued by the American Nurses Credentialing Center (ANCC) needs to be obtained within 1 year, or SW: Certified Social Worker in Health Care (C-SWHC) issued by National Association of Social Workers to be obtained within 1 year
• Bachelor's Degree in Nursing or Master’s Degree in Social Work
• Typically requires 5 years of experience in a relevant clinical setting.
• Includes 1 year of supervisory experience in a Care Management Leadership role.
• Ability to prioritize and organize work.
• Ability to travel and work across multiple sites as assigned (IL or WI)
• Effective communication skills.
• Utilization of critical thinking in timely decision making.
• Knowledge of MS Office products.
• Demonstrates leadership skills.
• Knowledge of Medicare A and B guidelines.
• Knowledge of Managed Care programs/requirements/implications.
• Knowledge of Conditions of Participation for Discharge Planning.
• Knowledge of requirement elements of Utilization Management program, including support of the UM Plan.
• Knowledge of Regulatory environment.
• Ability to work autonomously and respond to multiple requests effectively.

Nice To Haves

• Master of Nursing Administration, Master in Health Care Administration or related field preferred.

Responsibilities

• Provides management oversight of the daily operations of the care management and social work programs at the assigned site(s).
• Approves and monitors staff schedules, paid time off, and time cards to ensure continuity of services.
• Monitors proficiency of each site CM/SW staff and includes action plans to improve deficiencies, meet regulatory requirements, and drive efficiencies.
• Responsible for team building and conflict resolution.
• Facilitates performance improvement activities for the care management program; assists to establish measures, performance targets, and benchmarks to drive achievement of established goals and achieve efficiencies of processes.
• Collects, analyzes, and reports data to measure and identify the effectiveness of care processes and variations from standards and expectations.
• Analyzes data and information to discern root causes of performance gaps using key data and reports.
• Identifies and discusses overall and individual physician trends related to care management activities with Director of Inpatient Care Management Operations, Physician Advisor and site Medical Staff Leadership as appropriate with a documented improvement plan to include strategies and educational needs identified.
• Regularly reviews individual site successes and improvement opportunities with the Director of Inpatient Care Management Operations, site leadership and other key stakeholders.
• Serves as an internal consultant on Care Management opportunities.
• Acts as an expert resource for care management program, including evaluation of challenging cases, intervening with physicians when necessary, meeting with patients and families, dissemination and interpretation of key regulatory requirements and changes, etc.
• Consults, communicates, and organizes key ongoing education, serves as a supportive member of site UM Committees, and/or other site meetings as appropriate.
• Participates in multidisciplinary cross functional efforts to ensure high quality, cost effective coordinated care.
• Works collaboratively with Physician Advisor(s) on challenging cases, removing barriers to discharge.
• Accountable for site care management/social work budgets as assigned.
• Develops and recommends operational and capital budgets and controls expenditure within approved budget objectives.
• Ensures the care management/social work program operates within compliance of CMS, OSHA, Accrediting Organizations, and established care management practice standards and code of ethics.
• Collaborates with Compliance to ensure care management/social work program meets all state and federal guidelines.
• Responsible for orientation, and ongoing competency assessment of CM/SW staff in collaboration with the Director of Inpatient Care Management Operations.
• Responsible for personal professional growth.
• Participates in professional organizations, maintains license and certification as required, maintains effective working relations with both internal and external customers.
• Maintains required competencies and assumes responsibility of personal development and maintenance of ongoing workshops, conferences, and/or in-services and maintaining records of participation.
• Performs human resources responsibilities for staff which include interviewing and selection of new employees, promotions, staff development, performance evaluations, compensation changes, resolution of employee concerns, corrective actions, terminations, and overall employee morale.
• Develops and recommends operating and capital budgets and controls expenditures within approved budget objectives.
• Responsible for understanding and adhering to the organization's Code of Ethical Conduct and for ensuring that personal actions, and the actions of employees supervised, comply with the policies, regulations and laws applicable to the organization's business.

Benefits

• Paid Time Off programs
• Health and welfare benefits such as medical, dental, vision, life, and Short- and Long-Term Disability
• Flexible Spending Accounts for eligible health care and dependent care expenses
• Family benefits such as adoption assistance and paid parental leave
• Defined contribution retirement plans with employer match and other financial wellness programs
• Educational Assistance Program

What This Job Offers

• Job Type: Full-time
• Career Level: Manager