Manager FV Partners Care Coordinator - RN

Fairview Health Services•Edina, MN

20h

About The Position

Fairview Partners (FVP) provides high intensity care coordination and case management for seniors and other at-risk populations living in a variety of care settings in the 11-county metro area. The RN Care Coordination Manager assists the Director of Care Management in the day-to-day management of department care coordination staff and performs other administrative duties to support clinical operations, as assigned by the Director. The RN Care Coordination Manager assures that care is delivered according to department policy and models best practice in these case management functions: assessment, care planning, service coordination and referral, transition management, utilization management and quality assurance. Care coordination for the FVP population is delivered via partnerships with managed care organizations (MCO) and must adhere to regulations set forth by the MCOs, the Minnesota Department of Human Services (DHS), the Minnesota Department of Health (MDH) and the Centers for Medicare and Medicaid Services (CMS). This Manager RN care coordinator schedule includes; 80 hours ever two weeks Full time; Day shift No weekends

Requirements

Associate of Arts Associate Degree with five years nursing experience
5 years coordination/case management, public health, geriatric nursing or managed care experience
Clinical experience in a hospital and/or clinic setting, managing clinical professionals
Experience working with interdisciplinary clinical leadership teams on collaborative efforts
Supervisory/management experience
Strong knowledge of managed care programs, long-term services and supports, Medicare and Medicaid benefits and senior care industry
Excellent computing skills including keyboarding, Microsoft Word, Outlook and Excel and Adobe Acrobat; demonstrated proficiency with electronic medical record systems; excellent written and verbal communication skills
Registered Nurse

Nice To Haves

Bachelors Degree in Nursing
Seven to ten years of experience in care coordination/case management, public health, geriatric nursing or managed care
Minnesota Public Health Nurse license, Certification in Case Management or Geriatric Nursing
Drivers License
Basic Life Support (American Heart Assoc or Red Cross)
American Red Cross: CPR/AED for Professional Rescuers and/or Healthcare Providers, Life Guarding First Aid/CPR/AED
BLS Instructor

Responsibilities

Acts as the Manager for a Fairview Partners geographical area and/or clinical team:
Supervises a team of care coordinators, acting as immediate contact for staff questions and concerns
Conducts annual performance reviews with staff
Facilitates training opportunities for staff in coordination with department and system education resources
Actively encourages employee development and meets regularly with staff members on a one-on-one basis
Approves employee time cards and manages absenteeism according to system and department policy
Enforces all other department and system personnel policies
Acts as the hiring manager for approved positions in assigned area in consultation with the director
Is present during interviewing process for potential employees outside assigned area, at the request of the director
Serves as contact point for member complaints and grievances and has authority to reassign cases when necessary
Follows Fairview’s policy for corrective or disciplinary action
Rotates monthly case assignment with other managers and/or director
Assures that care coordinators work at the top of their licensure
Understands nursing scope of practice as it applies to the FVP RN Care Coordinator role and provides professional guidance to staff as needed
Represents Fairview Partners on system committees or workgroups, as requested by director
Covers duties in absence of other managers or director’s absence
Provides Care Coordination/Case Management to the FVP population:
Manages a panel of members in accordance with duties set forth in the FVP RN Care Coordinator job description
Models best practice in all areas of care coordination/case management
Gives clinical direction in accordance with CMS, DHS and health plan regulations
Provides guidance to Case Management Specialist role as it pertains to member communication, service referral authorization and appropriate delegation of care management tasks
Maintains department clinical operations
Maintains knowledge of current DHS policy concerning Long-Term Services and Supports, Medical Assistance benefit coverage and Elderly Waiver eligibility and benefits
Maintains knowledge of Medicare benefits and policy as it applies to health plan contracted services
Maintains knowledge of FVP clinical policies and network operations
Promotes the Fairview system care continuum and maintains professional relationships with system care partners
Coordinates with director to ensure updates from CMS, DHS, MDH and contracted health plans are distributed and understood by care coordination staff members
Serves as point of contact for health plan communication; responds to health plan inquiries in a timely manner
Attends all health plan care coordinator meetings
Attends DHS and other training events at the request of the director
Provides input to director for annual budgeting forecasts
Leads staff meetings and huddles, as directed by management
Actively supports quality and process improvements to achieve superior clinical outcomes and financial performance for FVP:
Participates in department quality and utilization meetings
Attends interdisciplinary team conferences and provides clinical guidance to care coordination team regarding high-risk and medically complex cases
Regularly reviews high-risk cases with team members to facilitate optimal clinical outcomes
Provides input on and leads clinical performance improvement projects
Supports efforts to maintain data integrity by enforcing department documentation and quality reporting standards
Assists with annual health plan audit preparation, as needed, and attends health plan audit reviews