COMPLEX CARE MANAGEMENT MANAGER - Covenant Healthcare : Job Details

Overview: The Complex Care Management Manager performs a dual role of leadership oversight and daily operations for the care management team while maintaining an assigned patient population. This position will lead, mentor, and develop a strong team, fostering a collaborative and results oriented environment for Complex Care Management Specialists, Patient Navigators, and Behavioral Healthcare Specialists. Responsible for training new staff, maintaining performance metrics, education, supporting performance measures and programs. In partnership with the primary care practice team, will lead care management/coordination for medically complex children and adults and act as a resource, and guides families and patients through disease self-management. Serves in an expanded health care role collaborating with specialists, the health care team, patients and families to ensure the delivery of quality, efficient, and cost-effective health care. Integrates evidence-based clinical and preventative guidelines, and protocols, in the development of patient centric individualized care plans. Assesses plans, implements, coordinates, monitors and evaluates all options and services with the goal of optimizing the patient?s health. The Complex Care Management Manager demonstrates excellent customer service performance in attitude and actions that are at all times consistent with the standards contained in the Vision, Mission and Values of Covenant Healthcare and the commitment to Extraordinary Care for Every Generation. Responsibilities:

Leadership Provide direct supervision, coaching, training, mentoring, and performance management to a team of RN and non-RN care management staff.

Participate in the recruitment, hiring, and onboarding of new care management staff. Address employee concerns. Performs corrective action, development plans, and performance appraisals. Monitor staff workload and assignments to ensure equitable distribution and efficient workflows.

Performs and coordinates coverage for vacation, medical leaves, jury duty, accurate reporting of employees? payroll time. Conduct regular team meetings and individual check-ins to ensure effective communication, discuss barriers, and identify staff training needs. Foster a positive, collaborative, and supportive team environment. Audit charts to ensure staff meet documentation requirements, verify billing, and meeting all policies and procedures. Monitor key performance indicators (KPIs) related to care management outcomes, such as readmission rates, length of stay, cost savings, gaps in care, and patient satisfaction. Ensure compliance with relevant regulatory requirements, accreditation standards, and payor guidelines. Participate in quality improvement initiatives and contribute to the development and implementation of performance improvement plans. Functions with an awareness of safety issues under the guidance of Director, demonstrates maintains all OSHA, MIOSHA, HFAP, Corporate Compliance regulations and legal issues. Develops and maintains smooth and effective relationships with all staff of Covenant HealthCare, the medical staff and affiliated agencies.Care Management/Behavioral Health Actively manages a caseload under the job duties of Complex Care Management Specialists and/or Behavioral Healthcare Specialists. Responsible for developing a comprehensive individualized plan of care and targeted interventions. Continually onitors patient/family response to plan of care and revises the care plan as indicated. Coordinates patient care through ongoing collaboration with PCP, patient/family, community, and other members of the health care team. Addresses and refers for social determinants of care needs, i.e. access to health care, educational, and psychosocial needs of the patient/family. Maintains required documentation for all Complex Care Management activities including patient progress and treatment recommendations in EMR that can be shared with treating providers and codes appropriately for services provided. Track patients follow up and clinical outcomes using a registry, within EMR or spreadsheet. Responsible for transition of care (TOC) calls, within two (2) business days of discharge, from an acute or semi-acute setting to home. TOC includes medication reconciliation, ensuring PCP or specialist follow-up appointments are arranged, assessing symptoms, teaching warning signs, reviewing discharge instructions, coordination of care, and problem-solving barriers. Works with practice and PO/PHO leadership to continuously evaluate process, identify problems, and propose/develop process improvement strategies to enhance care management and Patient Centered Medical Home delivery of care model. Provide back-up support to other CMG/PHO sites as needed. Performs all other duties as assigned.

EDUCATION/EXPERIENCE Bachelor's degree in nursing required. In lieu of bachelor's degree in nursing, a candidate with associate's degree in nursing and five (5) years nursing experience who is committed and willing to obtain a bachelor's degree in nursing within four (4) years upon hire in position will be considered. Must have a current Registered Nurse (RN) to practice in the State of Michigan. Certification in Case Management (CCM) or other relevant certification preferred. Minimum three (3) years of experience with adult medicine and pediatric patients in primary care/ambulatory care, home health agency, skilled nursing facility, or hospital medical-surgical setting within the past five years preferred. Prior supervisory or leadership experience preferred. Case management or care management experience preferred. Experience working with patients who have chronic conditions; working with community agencies and health care providers; and self-management support preferred.KNOWLEDGE/SKILLS/ABILITIES Strong clinical knowledge, leadership skills, and a deep understanding of care management principles and best practices. Knowledge of payor guidelines and quality improvement principles. Familiar with revenue cycle, including coding, billing and A/R. Time management and organizational skills, Self-directed. Ability to make quality, independent decisions while exercising sound judgment in difficult and sensitive situations. Demonstrates ability to develop positive, longitudinal relationships and set appropriate boundaries with patients/families. Excellent computer knowledge and capability to use computer; i.e. Microsoft Word, Excel. Epic experience preferred. Ability to travel to work in the physician offices, attend meetings and conferences as needed. Demonstrates customer focused interpersonal and leadership skills, and the ability with the understanding of cultural diversity to interact in an effective manner with practitioners, patients, and families. WORKING CONDITIONS/PHYSICAL DEMANDS Ability to maintain regular, punctual attendance consistent with the ADA, FMLA and other federal, state and local standards. Constant Sitting, near vison, finger dexterity, talking, hearing, tasting/smelling. Frequent Depth perception. Frequent lifting up to 10 lbs. Occasional Standing, walking, lifting/carrying, pushing/pulling, stooping, kneeling, crouching, squatting, crawling, far vision.

Occasional lifting up to 50 lbs.