Manager, Social Support Complex Care

About the role

We’re changing lives every day—for both our patients and our team members. This is a regional leadership position accountable for the direction, leadership, and support of our Social Complex Care Coordinators, Social Support Supervisors, Social Support Managers, and all members of the Social Support team in delivering the day-to-day programmatic acute care strategy. These teams are dedicated to managing our complex care patients in meeting their social and/or behavioral health needs and ensuring their care in all environments is appropriate.

In collaboration with the PCP, center staff, and other members of the Complex Care team, this role provides program management for complex patients to ensure the patient’s progression through the continuum of care in a manner that achieves the desired clinical outcomes and effective resource management. The role promotes consistent application of effective processes and social service accountability. The incumbent is responsible for their team’s assigned patient caseload and proactively manages patients to prevent unnecessary hospital arrivals. Success is measured by the team’s impact on preventing unnecessary hospital arrivals related to social needs.

This role may directly manage a regional team across multiple areas and serves as coach, mentor, and trainer to all members of the social support complex team, providing guidance in best practices and troubleshooting to optimize care in hospital and community settings.

Responsibilities

• Manages a team of Social Workers, Licensed Social Workers, Social Support Coordinators, and Behavioral Health Coordinators.
• Actively involved in the full employment cycle of direct reports, including recruitment, annual performance appraisals, day-to-day oversight of staffing/scheduling, problem-solving, exit interviews, and termination/counseling decisions.
• Provides structure and assures consistent execution of the Social Support Process strategy and execution plan to reach yearly outcomes.
• Plays a key role in the Case Management Process (CMP), a collaborative model including patients, nurses, social workers, PCPs, specialists, other providers/practitioners, and caregivers.
• Coordinates care with PCPs, Specialists, and ancillary teams across the market.
• Advocates for and assists Intensive Community Managers, Post Acute Manager, Acute Care Manager, and all members of the Complex Team with ensuring patients achieve optimal health, access to care, and appropriate utilization of resources.
• Consults with, encourages, and influences physicians, specialists, and other providers to refer patients to complex social support management for assessment, planning, implementation, coordination, monitoring, and evaluation to develop an individualized care plan prior to hospitalization.
• Aids in identifying areas of opportunity at the PCP, center, and market level.
• Serves as the Social and/or Behavioral Health “expert” to support Social Support team members, Complex Care team, and center staff needs for market-specific education.
• Facilitates medication reconciliation and adherence education; disease education and coaching; advance directive/end-of-life discussions; and referral/authorization management with Social Support team members as needed.
• Educates and supports Social Complex Managers and Social/BH Complex Coordinators at appropriate intervals, assesses and reassesses patient progress, and urges appropriate interventions to obtain optimal outcomes.
• Monitors and manages social/BH and financial coordination of treatment plans to ensure timely, cost-effective, individualized service delivery to prevent unnecessary hospital arrivals, ensure appropriate medication use, and coordinate specialty care.
• Provides active Social Complex Manager/Coordinator duties to a small caseload based on regional needs and supports catastrophic cases within the clinical support group.
• Assists with development and implementation of case management policies, processes, and standard operating procedures (SOPs).
• Precepts new Social Complex Managers and Social/BH Complex Coordinators.
• Assists with quality audits and data analyses to identify opportunities for improvement.
• Identifies problems or dissatisfaction experienced by patients or referring sources and works to resolve them to a high degree of service excellence.
• Formulates, implements, and evaluates educational strategies for staff to provide the best outcomes for patients and family members.
• Facilitates inter-disciplinary rounds in conjunction with market, regional, and home office physicians and leaders for discussion of complex needs and follows up on action items.
• Monitors, reports, and addresses areas of opportunity, progress toward goals, KPIs, and daily actions of the regional team.
• Identifies and shares best practices to advance efficiency and performance.
• Assists with workflow efficiency improvement for clinical and operational practices.
• Works with Complex Care COE for development and implementation of best practices.
• Manages resources within established budget parameters while actively participating in identification and implementation of cost-saving strategies.
• Performs other duties as assigned and modified at manager’s discretion.

Requirements

• A valid, active Registered Nurse (RN) license in the state of employment OR a Bachelor’s degree in Social Work.
• One of the following preferred degree conditions:
  • Bachelor’s Degree in Nursing (BSN); OR
  • Associate degree in Nursing (ADN) with 2 years’ home health, case management, or discharge planning work experience; OR
  • Bachelor’s degree in a health-related discipline.
• Compact license required if available in state.
• A minimum of two (2) years’ work experience in social work, case management, and/or discharge planning.
• State Licensure at a Master’s Level is preferred but may be required (dependent on state). If applicable, incumbent must be compliant with the mandatory laws of state licensure at the Master’s level.
• A minimum of 5 years’ clinical work experience preferred.
• Experience in Clinical/Social/Behavioral Health Management with a minimum of 2 years’ utilization review and/or case management, home health, and/or discharge planning experience highly desired.
• Basic Life Support (BLS) certification from the American Heart Association (AMA) or American Red Cross required within the first 90 days of employment.
• This position requires possession and maintenance of a current, valid Driver’s License.
• Case Management Certification through the Commission for Case Manager Certification (CCMC) or the American Association of Managed Care Nurses (AAMCN) preferred.
• Hospital or healthcare setting experience preferred.
• Experience with psychological aspects of care desired.
• Leadership experience in a healthcare setting (e.g., lead nurse, charge nurse, nursing supervisor) highly desired.

Skills

• Strong business acumen and experience in data analytics.
• Excellent verbal and written communication skills to effectively connect with diverse populations, including physicians, employees, patients, and their families; comfortable giving group presentations.
• Teaching abilities to conduct educational programs for PCPs, ChenMed staff, and tier-one hospital staff clearly and concisely.
• Knowledge of care delivery capabilities along the continuum of care.
• Superb interpersonal and critical thinking skills to work productively with all levels of organization personnel and to supervise the activities of a group of employees.
• Resourcefulness to identify prompt and sustainable solutions to barriers in care delivery.
• Leadership skills to direct others toward objectives that contribute to the success of the business unit. Ability to supervise and train employees, including organizing, prioritizing, and scheduling work assignments.
• Ability to cope with stressful situations and manage multiple, sometimes conflicting priorities simultaneously.
• Flexibility with schedule, including off-shifts, weekends, and holidays to meet the needs of patients, families, or staff.
• Fiscal skills to monitor and control costs and revenue.
• Familiarity with professional and technical emerging knowledge.
• Excellent knowledge of case management principles, healthcare management, and reimbursement.
• Excellent organizational and time management skills.
• Proficient in Microsoft Office Suite products including Excel, Word, PowerPoint, and Outlook, plus a variety of other word-processing, spreadsheet, database, e-mail, and presentation software.
• Ability and willingness to travel locally, regionally, and nationwide up to 30% of the time.
• Spoken and written fluency in English; bilingual preferred.

Pay

The posted pay range for this position is $91,165 - $130,235 annually. Final compensation will depend on a variety of factors including but not limited to experience, education, geographic location, and other relevant factors. This position may also be eligible for bonuses or commissions.

Benefits

ChenMed offers comprehensive benefits, career development, and advancement opportunities. For more details, visit ChenMed Employee Benefits.