Care Management Supervisor (RN) Mettowee

Job Description

Job Description

COMMUNITY HEALTH:

Community Health is a primary care network that provides nationally-recognized programs, a focus on wellness, dental, behavioral health and pediatric specialties, walk-in Express Care, a culture of community and quality health care that almost everyone, insured or uninsured, has come to depend on. As an equal opportunity employer, we offer a team-oriented, collaborative work environment for close to 400 employees at eight different locations in Rutland and southern Addison counties.

ABOUT THE ROLE:

The Care Manager Supervisor will facilitate and ensure a structured, thoughtful, planned, and integrated plan of care and process for all Community Health patients. They will oversee care management to include staff development, compliance, and quality improvement, while ensuring that clinical standards and regulatory requirements are met. They will help in the identification of patients at risk based on risk stratification. They will have a high level of knowledge re. high utilizers of ER services and patient readmissions. Will work directly as a team member providing Care management services in the designated Practice and coverage if necessary.

1. Collaborate with interdisciplinary team.

• Clearly communicates their role with healthcare team and actively participates in team planning for patient care.
• Participates in development of care plans or other programs/projects that maximize continuing care efficiencies and effective outcomes.
• Provide employee assistance on request.
• Be an advocate for patients when in need of Community Health Services
  

1. Professional behavior and development

• Maintains principles of the organization’s values.
• Identifies personal and professional goals.
• Pursues continuing education relevant to career goals.
• Abides by the profession's code of ethics and conduct.
• Provides education on patient rights and responsibilities.
• Participates in hospital-wide committees, initiatives, and projects.
• Provides and participates in community services and education.
• Conducts self in a professional manner with patients, families, RRMC and community colleagues.

1. Provides Information/Referral Services for Community Resources

• Maintains constant awareness of area resources, eligibility criteria, and updates on changes in these services.
• Keeps updated on out-of-area resource information relevant to patient needs.
• Liaisons to legal, licensing and protection agencies
• Understands relevant insurance, regulatory, and legal system issues relevant to the care of patients in an outpatient setting.
• Advocates for system change to improve continuing care outcome.

1. Participates in Required Departmental Activity

• Regularly coordinates and attends required staff meetings, supervision and related projects or committee meetings.
• Completes work as assigned.
• Completes daily statistics utilizing Tableau and other data resources in a timely and accurate manner.
• Participates in coverage of peers on an as needed basis.
• Demonstrates collegiality and commitment relevant to the department’s mission.
• Provide Care Management consultation to all locations as needed.

1. Provides Clinical Supervision

• Perform all supervisory functions for members of the Care management Team.
• Conduct case reviews, audits patient charts as necessary, ensures policies are being followed including documentation timelines.

• Reviews clinical documentation for accuracy and continuity with quarterly chart audits
• Conducts biannual and /or designated reviews.
• Performs all 90-day reviews.
• Assists Director of Population Health & Quality with program planning, implementation, evaluation activities, and other duties as assigned.
• Conduct interviews for all potential candidates.
• Ensures that team provides CCM services for those that qualify in the Medicare/Medicaid program.
• Actively participates and coordinates in any quality management initiatives.
• Investigates and supports grant writing efforts.
• Works with the CHT (Community health Team), SASH, VCCI, RMH and other community resources to coordinate care.

Clinical and Administrative Duties

• Works with billing department to ensure services are being billed correctly.
• Coordinates Primary Care Management services at all Community Health sites.
• Assists in the training and coordination of Training/Education of new Care Management staff.
• Participates in community collaboratives that have an impact on optimal care management services.
• Conducts performance evaluation at regular intervals.
• Participates in hospital-wide committees, initiatives, and projects.
• Actively invoices CHT invoices for Care management services.
• Evaluates staff for established/anticipated productivity standards.
• Communicate with referral sources and maintain relationships that enable ongoing communication.
• Make collateral contact with the primary care providers Clearly communicates the social work role with healthcare team and actively participates in team planning for patient care.
• Participates in development of care plans or other programs/projects that maximize continuing care efficiencies and effective outcomes.
• Provides employee assistance on request.
• In collaboration with Human Resources, provides counseling and discipline when needed.
• Creates, adjusts and reviews EMR workflows.
• Other duties as assigned.

SKILLS REQUIRED FOR SUCCESS:

• Current Vermont RN.
• CPR Certification.
• Prior experience working in a nursing position required; prior case management experience in a similar outpatient setting preferred.
• Experience in using a variety of electronic medical record and ability to learn other systems, basic keyboarding skills and email communication.
• BSN, CCM certified preferred.

HOW WE SUPPORT YOU:

• Work Life Balance
• Generous Time Off
• Medical, dental, and vision insurance.
• Health savings account option.
• Robust 403 (b) retirement savings plan, with employer match and 100% vesting schedule.
• Comprehensive Wellness Program.