Director of Care Management

INTRODUCTION

Under the direction of the VP of Nursing, the Director of Care Management is responsible for the oversight of the Care Management team(s) under Unity Health Care's PCMH (patient centered medical home designation) model. The Director of Care Management is an experienced Registered Nurse (RN) leader who is responsible for the oversight, management and growth of Unity's care management team, MHGPS nursing team, the virtual care team, the transition of care nurses, and other initiatives that may be subsequently assigned. The Director of Care Management provides leadership and oversight for these programs with the goal of enhancing patient care quality and satisfaction and promoting care continuity and cost-effectiveness through the integration of care coordination, care management, utilization review, navigation, relationship development and outreach.

MAJOR DUTIES/ESSENTIAL FUNCTIONS

Essential and other important responsibilities and duties may include, but are not limited to the following:

• Accountable directly to the VP of Nursing
• Responsible for the supervision of the team staff (nurses and medical assistants)
• Responsible for the development and implementation of the nursing care management program and ensuring patients with chronic health conditions or special needs have access to care management at UHC
• Oversees the compliance for PCMH clinical teams, My Health GPS (MHGPS), virtual care teams, and the transition of care team
• Leads the nurse care management team in managing the effectiveness of the patient centered medical home delivery model, including the evaluation of program outcomes and individual staff productivity and performance
• Manages staffing, activities and data to impact strategic objectives and pay for performance goals, on efforts to reduce unnecessary utilization of emergency rooms, avoidable hospitalization, and avoidable readmissions
• Provides leadership and vision in strategies to improve health outcomes and address social determinants of health in collaboration with case management
• Ensures program integrity and excellence by ensuring activities are informed by evidence-based practices
• Develops workflow for development and tracking of care plans for patients
• Establishes standardized procedures for monitoring activities and outcomes
• Ensures adequate documentation of effort and outcomes for compliance
• Establishes data collection standards and reviews staff data collection at least monthly to ensure accuracy
• Ensures that all nurse care managers conduct outreach to the patient within one (1) business days after discharge to support transitions from inpatient back to the outpatient setting
• Ensures that patients discharged from hospitals have adequate care and support and regularly checks up on progress
• Evaluates the quality of care in care-management panels through a clinical and population health lens by assessing appropriate levels of care and support services for patient panels
• Participates in multidisciplinary quality and service improvement committees as appropriate
• Serves as representative of the care management department and UHC in community outreach and external stakeholder collaboration efforts as appropriate
• Assists with generating reports which may include analysis of patient populations, efficacy of education, tracking of interventions, UDS reports, etc.
• Secures patient information and maintains patient confidence by completing and safeguarding medical records and keeping patient information confidential
• Coordinates with Clinical Nurse Managers and Medical Directors as needed, including in the management of clinically related patient complaints, unusual incident reports, HIPAA and OSHA incidents
• Meets with staff regularly and provides ongoing coaching, feedback and support, including opportunities for professional development
• Reviews the performance of team members in a timely manner, including completing 90 day and annual performance evaluations per their due dates and documenting any issues or change
• Performs other duties as assigned.

MINIMUM QUALIFICATIONS

• Bachelor's degree in Nursing (BSN). Master's degree in Nursing, Education, and/or health related field preferred.
• Care management experience highly preferred
• Experience with working with MCOs required
• Current DC RN license.
• CPR Certification.
• Five (5) years of clinical experience with three (3) years management/supervisory experience.
• Additional background in healthcare management preferred.

REQUIRED KNOWLEDGE, SKILLS & EXPERIENCE

• Ability to articulate the mission of Unity Health Care through his/her works.
• Demonstrated proficiency with business software (e.g. Microsoft Office Suite).
• Experience using electronic medical records preferred.
• Independent decision maker and be able to lead and manage people in a motivational and constructive way, individually and in a group setting.
• Knowledge of primary care and health maintenance.
• Strong verbal and written communication skills required.
• Strong organizational skills with an ability to multitask.
• Demonstrates ability to function effectively in a team required.
• Ability to travel between UHC sites or relocate to a different UHC site on a full or part-time basis required.
• Ability to work some weekends if needed; Flexibility required.
• Available to work on-site with some opportunities to work remotely.
• Excellent work ethic, good people management skills and the ability to perform well in stressful situations.
• Demonstrated ability to effectively work and communicate with diverse populations.