Manager - Continuum of Care
Title: Manager – Continuum of Care
FTE: 1.0 FTE
Schedule: Monday - Friday
Holiday Rotation: N/A
Weekend Rotation: N/A
On Call Requirements: N/A
The Manager of Continuum of Care coordinates the design, development, implementation, and monitoring of the organization’s case management services and the Medicare and MA Utilization Review Program. Manages clinical and support staff in the performance of medical management functions, including case management, inpatient discharge planning and Medicare and MA utilization review. Functions as the internal resource on issues related to the appropriate utilization of patient care resources, coordination of care across the continuum and Medicare / MA utilization review and management.
The Manager works collaboratively with clinic leadership, clinical directors, physician leaders and other key stakeholders to maximize the quality of care and the patient experience, while also addressing the cost effectiveness of care.
POSITION TECHNICAL RESPONSIBILITIES
- Provides general oversight and coordination of daily operations of one or more departments.
- Assume leadership role in establishing and achieving department goals. Assist in the development of new services lines and/or programs. Prepares project specific reports. Accomplishes daily department objectives by managing staff; planning and evaluating department activities. Directly oversees and addresses daily operational needs, typically for multiple cost centers. Reviews, analyzes, develops and implements department workflow processes to increase efficiency, accuracy and decrease re-work. Assists with development of policies, procedures, and productivity standards. Conducts daily rounds on team members to ensure optimal workflow and addresses daily staffing needs
- Addresses department staffing assignments daily, ensuring optimal workflows are implemented. Evaluates staff workloads to ensure equitable distribution of work and to determine appropriate staffing levels
- Responsible for addressing human resource needs (e.g. interviewing, hiring, training and development, annual evaluations, etc.).
- Sets goals for individual team members that are in alignment with the department’s and organization’s goals. Holds personnel accountable for all activities outlined in their job descriptions, Service Excellence Standards, and other organizational requirements. Trains and onboarding new hires to make sure they understand their roles. Communicates job expectations. In consultation with supervisor, coaches, counsels, and applies corrective action to employees as needed.
- Approves payroll for assigned team members.
- Works directly with staff to maintain compliance with external regulations and internal policies
- Works directly with staff to maintain quality service by enforcing quality and customer service standards, analyzing and resolving quality and customer service problems, and recommending system improvements.
- Actively reviews staff use of materials, equipment, etc. and provides feedback to staff to ensure best use of resources.
- Interprets and explains policies from leaders to staff. Function as a liaison between physicians, administration and staff.
- Participate in developing and monitoring assigned budgets. Analyze budget reports monthly to identify and correct for variances. Identify and implement cost containment programs to be fiscally responsible.
- Serve on organizational committees as assigned.
- Occasionally provides services at the staff level during periods of staffing instability.
- Work collaboratively with SPH and community partners to connect and coordinate services across the continuum (acute care, primary care, specialty care, long term acute care hospitals, sub-acute level of care, long term, case management and social work, post-acute providers) to optimize clinical outcomes and resource stewardship.
- Support facilitation of a comprehensive, cohesive, and coordinated approach to the care of patients over time, in multiple environments and across the entire spectrum of healthcare services delivery at SPH.
- Support Director and other key stakeholders to ensure that strategies and tactics are identified and operationalized across the organization - ultimately leading to improvements in care coordination, especially for our high risk and complex patients.
- Support provision of a multi-disciplinary forum with an SPH perspective to evaluate strategic and tactical issues related to the continuum, pilot ideas for new methods of delivering care (e.g., partnerships with senior centers to address the healthcare needs of the frail elderly).
- Study and assist in the development of best practices for managing post-acute patient care.
- Study and analyze the financial and clinical services’ impact of current continuum care practices.
- Work with leaders in case management, social work, SNF partners, and post- acute providers to assess current resources and expertise. Then, with the assessment reimagine and deploy resources across the continuum that decrease care fragmentation and enhance care understanding for all patients.
- Function as the subject matter expert on care coordination evidence and innovation.
- Manages patient concerns/grievances
Medicare and MA Utilization Review Program
- Assures the organizational UR Program is compliant with CMS requirements for Hospital Condition of Participation.
- Ensures that Medicare / MA utilization functions are completed as described in the UR Plan.
- Manages the Utilization Review Committee and the maintenance of the committee’s work products.
- Serve as a technical expert and internal resource to assist in determining admission status and documentation standards.
- Interprets federal regulations and provides recommendations for department and hospital compliance.
- Develops and maintains management information systems to support analysis and reporting on UM functions and systems. Provides interpretation and analysis of UM-related data.
- Required: Bachelor’s Degree in Nursing
- Preferred: Master’s Degree in healthcare, business administration, or healthcare-related discipline
- Required: Experience in a hospital or clinic setting. Experience interpreting healthcare regulatory standards. Experience in utilization review.
- Preferred: None
- Required: Current State of Wisconsin License as a Registered Nurse.
- Preferred: None
- Required: None
- Preferred: American Case Management (ACMA) Case Management certification.
- Competitive health and dental insurance options
- Flexible paid time off to balance work and life
- Retirement plan with immediate vesting and employer match
- Free membership to our state-of-the-art fitness facility
- Generous tuition reimbursement
- Employer provided life and disability insurance
- Free parking at facility
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