ACO Clinical Care Manager Essential Duties and Responsibilities:
- Lead, mentor and supervise staff:
- Responsible for the recruitment, orientation, evaluation, coaching, counseling, and disciplinary action of care management clinical and administrative staff.
- Monitors staff effectiveness and collaborates with ACO Director in facilitating professional development and celebrating achievements.
- Onboards new Care Management staff and facilitates training and development processes to ensure staff are set up for success.
- Develop individual staff educational plans and implementation of annual training for skill and career development of staff.
Manages operations to ensure optimal program performance:
- Manages and assumes responsibility for oversight of day-to day-operations of ambulatory Care Management including population health management, care coordination, case management, and discharge planning activities.
- Manages process of population health screening and stratification to identify patients for appropriate care interventions.
- Performs outreach and education to referral sources: ensure appropriate triage, oversee care management activities, and referral source communication and workflow.
- Monitors program effectiveness, identify opportunities for improvement, and assist director in enhancement strategies.
- Supports budget development and management of resources within budget parameters.
Provides clinical support:
- Reviews cases regularly with staff; acts as clinical consultant regarding care management issues; guides clinical staff with review of assessments and care plans; evaluate documentation.
- Performs monthly audit of charts on care management activities, including discharge planning, to identify patient-specific and staff-specific opportunities to enhance health outcomes.
- Participates in daily patient huddles and supports staff in prioritization and problem solving.
Establishes and maintains effective collaborative relationships with system and external colleagues:
- Works collaboratively with inpatient and outpatient providers to assure effective transitions of care.
- Collaborates with the Director of Inpatient Care Management on programs and projects that improve the care and experience of the patient across the continuum of care.
- Provides relief coverage of inpatient care management.
- Participates in strategies to decrease patients with frequent ED utilization and readmission.
Ensures compliance with requirements:
- Assist ACO Director in establishing, implementing, and ensuring that care management policies, practices and procedures are in accordance with the Joint Commission, and other regulatory agencies and overall hospital policies.
- Oversee submission of any audits, including but not limited to Medicaid, Medicare, and internal compliance studies.
- Excellent interpersonal skills and abilities in relating to people at all levels to represent CHP professionally and negotiate, sell, motivate, and coach successfully.
- Retains administrative oversight for Care Management. Provides specific direction for personal growth to management and lead staff. Utilizes CHP values and strategic goals to drive performance.
Competencies: To perform the job successfully, an individual should demonstrate the following competencies:
- Excellent verbal and written communication.
- Excellent multi-tasking, communication, and organization skills.
- Detailed oriented.
- Ability to understand people and situations.
- Ability to provide people-centered care.
- Ability to improve nursing quality.
- Behave ethically and professionally.
- Work with diverse populations.
- Collaborate well with others.
Essential Skills and Qualifications: To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
- Five years of clinical experience in a directly related setting (outpatient clinical setting}
- Three years of case management / social work experience.
- Two years of experience in a supervisory/management or lead role.
- Certification in Case Management preferred.
- Previous direct experience in managing or leading government/ACO programs preferred.
- Previous direct experience with MassHealth, programs preferred.
- Previous experience with behavioral health and substance use disorder preferred.
Education and Training:
- Bachelor’s Degree in Nursing and/or related healthcare discipline required.
- Master’s Degree in nursing is preferred.
- Master’s Degree in Social Work required. (If qualifying via the LICSW requirement below)
- Understanding of patient-centered care principles, population health management, stages of change, self-determination
License, Certification & Registration:
- RN/LICSW - RN License/BS degree or LICSW in MA.
- Certification in Care Management is preferred
- Current CPR certification required.