Manager, Care Management

About the Role

Under the supervision of the System Director of Care Management, the Manager of Care Management is responsible for supporting all daily operations of the departments at Woman and Infants Hospital (WIH). The Care Management Manager provides leadership assistance and support to maintain department focus on reaching established departmental goals.

Responsibilities

• Supports departmental operations to ensure consistency with health system/department policies under supervision of the System Director of Care Management
• Works in collaboration with Director to oversee new employee hiring, orientation, and competency evaluation
• Displays sound managerial judgment in all areas
• Assists System Director of Care Management in planning and monitoring department budget
• Provides service in the most cost-effective manner without compromising the quality of care or customer satisfaction
• Maintains performance, patient and employee satisfaction, and financial standards
• Adheres to CNE facility and department policies and procedures as well as standards from external regulatory agencies and accrediting bodies (i.e., Joint Commission, CMS, etc.)
• Assists the hospital and department in meeting and exceeding their commitment to continuous quality improvement
• Assists System Director of Care Management in the planning and implementation of opportunities and new ideas to promote department growth and development
• Supports and leads department strategies and efforts focused on improving key care management metrics
• Assists System Director of Care Management with establishing performance improvement initiatives
• Supports and participates in departmental strategies and efforts focused on improving clinical documentation by physicians
• Designs and develops processes related to Care Management as assigned by Director
• Maintains knowledge of the hospital mission, vision, and values and functions to support them
• Maintains confidentiality at all times related to both patient and employee information
• Develops and updates department orientation/mentoring process for Care Managers and other department staff
• Supports ongoing education and development of Care Managers and other department staff
• Monitors compliance with established policy/procedure and communicates opportunities for improvement to staff
• Assists Director in competency assessments for all staff through audit reviews, shadowing, and performance metrics
• Takes actions to assure improvement on the employee satisfaction survey
• Assists with implementing and evaluating the Department’s daily operations
• Supervises, initiates, and recommends personnel actions for staff
• Approves staffing, assignments, coverage, employee PTO, and payroll approval to ensure appropriate staffing coverage
• Assures appropriate weekend, holiday, and off-hours coverage for hospital
• Remains on-call 24/7 for clinical staff as back-up
• Serves as a departmental resource and manages issues/problems escalated by staff
• Holds regularly scheduled Care Management Department staff meetings
• Facilitates training sessions to educate assigned users of applicable case management systems
• Builds and maintains professional relationships with payers and external agencies and keeps staff updated regarding changes
• Builds and maintains professional relationships with unit managers, Physician Advisor, and CNE leadership to help facilitate aligned goals
• Serves as department lead and clinical expert for Cerner, Careport, InterQual, and other department applications
• Assists with scheduling, coordinating, and training of applications
• Collaborates with System Director in completion of annual performance evaluations for both Care Managers and other department staff
• Attends rounds and maintains a daily working knowledge of cases, helps staff develop solutions to barriers that prevent appropriate discharges
• Maintains knowledge of daily caseloads of staff as it pertains to Discharge Planning and Utilization Review and makes decisions to ensure that daily work is completed as required
• Maintains a current knowledge of length of stay data and helps develop strategies for improvement
• Develops data from rounds regarding patient discharge information
• All other duties as assigned

Requirements

• Bachelor of Science Degree in Nursing or proof of academic achievement towards a Bachelor's degree in Nursing or related field and must be currently enrolled in a Bachelor's program with a targeted date of completion required
• Master’s degree or proof of academic achievement toward a Master’s degree in Nursing or related field and must be currently enrolled in a Master's program with a targeted date of completion preferred
• Four years of acute care hospital environment experience required
• Care Management experience required
• Current RN License in Rhode Island
• Certification in Care Management, CCM or ACM required (upon hire will obtain Certification in Care Management within one year of hire if not already in place)
• Basic Life Support (BLS) certification required

Skills

• Ability to establish priorities, meet deadlines, and maintain productivity
• Ability to form positive collaborative relationships with hospital staff, physicians, patients, families, and post-acute providers
• Ability to problem solve in a proactive, creative manner using sound judgment based on factual information and clinical knowledge
• Excellent leadership skills and supervisory experience required
• Ability to lead and actively participate in multidisciplinary teams
• Knowledge and training in multiple computer systems required to perform position responsibilities (i.e., Cerner, InterQual, 3M, Microsoft Office, etc.)
• Ability to work independently and within a team structure
• Excellent interpersonal skills and communication style
• Working knowledge of regulatory, Medicare, Medicaid, and third-party payer compliance requirements

About Us

Care New England Health System (CNE) and its member institutions—Butler Hospital, Women & Infants Hospital, Kent Hospital, VNA of Care New England, Integra, The Providence Center, and Care New England Medical Group—is a trusted, integrated health care organization that fuels the latest advances in medical research, attracts the nation’s top specialty-trained doctors, hones renowned services and innovative programs, and engages in the important discussions people need to have about their health and end-of-life wishes. Care New England is helping to transform the future of health care, providing a leading voice in the ongoing effort to ensure the health of the individuals and communities we serve.