Under the direction of the VP of Population Health Management, the Manager of Care Management, SCO oversees the performance and daily operations of the SCO Care Management Program. The Manager ensures that the delivery of care management and related care coordination activity is based on established protocols, policies, procedures, practice standards, and applicable contract and model of care requirements. The Manager provides day-to-day oversight of team practice and ensures appropriate delegation of responsibilities.
KEY FUNCTIONS/RESPONSIBILITIES:
- Provides leadership and direction to assigned clinical and support staff to ensure practice standards supporting care management are met
- Ensures that resources are prioritized and allocated based on member needs and acuity level
- Monitors staff productivity and balances staffing and responsibilities accordingly
- Oversees the assessment of and care planning for members in the care management program
- Monitors caseload assignments and member acuity daily to ensure timely and accurate member assessment and care planning
- Oversees staff responsible for monitoring assessment status and completion and entry into the Virtual Gateway
- Oversees Transition of Care team and processes and ensures compliance with practice guidelines
- Utilizes metrics and reports to ensure work is allocated timely and appropriately and meets regulatory compliance requirements, member needs, and performance standards
- Provides direction and support to ensure and maximize program effectiveness and efficiency including development and monitoring of reports, dashboards and, with the VP of Population Health Management, develops benchmarks, and ensures compliance with state and federal requirements
- Monitors care management performance through case reviews, chart audits, supervisory activities, and identifies opportunities for competency development
- Interviews, hires and assists in orientation and training of employees
- Promotes a positive team environment that advances team-based learning and member management
- Develops work flows and processes, call schedules and other activities to support care management operations
- Works with staff to resolve and make recommendations related to member and/or provider concerns or care issues as necessary
- Accountable for timely notification to the VP of Population Health Management if team or performance falls below expectations, and works with leadership to develop an improvement plan to improve
- In collaboration with the VP of Population Health, UM Director, Medical Director and Quality Director, assesses utilization drivers and risk triggers
- Identifies utilization risks and medical trend management opportunities
- Develops and maintains positive relationships with all members of the clinical team including physician leaders and interdepartmental staff supporting the SCO program
- Collaborates cross-functionally to ensure operational requirements are facilitated to support care management
- Identifies members for rounds and clinical review
- Consults and collaborates with the Quality Improvement and Clinical Informatics departments on an ongoing basis to ensure the care management program, metrics and performance are consistently meeting targets established for MassHealth Quality Improvement Goals, Annual Quality Improvement Work Plan goals and External Quality Review Organization goals, and other initiatives, as appropriate
- Engages in clinical quality initiatives and manages measures associated with key performance indicators
- Provides oversight, data, and input into regulatory reviews, reports, and audits and prepares corrective action plans as needed
- Represents SCO Care Management on internal and external committees/forums, as directed by the VP, Population Health Management
SUPERVISION EXERCISED:
- Responsible for the supervision of Care Management supervisors and care management clinical and non-clinical staff
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SUPERVISION RECEIVED:
- Weekly supervision with VP of Population Health Management
QUALIFICATIONS:
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EDUCATION REQUIRED:
- Registered Nurse
- Bachelor’s degree or an equivalent combination of education, training and experience is required
EDUCATION PREFERRED:
- Master’s degree in nursing or health related/public health field preferred
EXPERIENCE REQUIRED:
- 3-5 years’ experience in a leadership/supervisory role
- Experience using metrics and reports to monitor performance, allocate workloads, and monitor medical and utilization trends
EXPERIENCE PREFERRED/DESIRABLE:
- Experience conducting in-home assessments, specifically the MDS-HC and MDS 3.0 is highly desirable
- Work with geriatric populations and Medicaid a plus
- Work with an integrated care model/use of supportive services a plus
REQUIRED LICENSURE, CERTIFICATION OR CONDITIONS OF EMPLOYMENT:
Successful completion of pre-employment background check
Active, unrestricted MA Registered Nurse license, required
Certification in case management (CCM) preferred
Ability to take after hours calls, including evening/nights/weekends
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COMPETENCIES, SKILLS, AND ATTRIBUTES:
- Strong management skills
- Excellent organizational skills
- Ability to use Excel and management reports to monitor work, review trends, and measure performance
- Strong interpersonal skills
- Ability to support, motivate and guide others
- Flexible, independent, self-starter
- Ability to work collaboratively and build strong relationships across departments and with providers
- Demonstrates commitment to quality
- Intermediate to advanced Windows and Microsoft Office skills
- Strong oral and written communication skills
WORKING CONDITIONS AND PHYSICAL EFFORT:
- Regular and reliable attendance in the central office is essential
- Fast paced office environment
- Work is normally performed in a typical interior/office work environment
- Travel within the SCO geographic network required
- No or very limited physical effort required. No or very limited exposure to physical risk
Required Skills
Required Experience