The Manager, Intensive Community Complex Care (ICC) is a regional leadership position responsible for leading the ICC team to deliver on managing their case load by providing onsite and remote planning, clinical group leadership and expert technical guidance. These teams are dedicated to managing our complex care patients in meeting their clinical needs and ensuring their care in all environments is appropriate. This role, in collaboration with the PCP and healthcare teams, provides program management for complex patients to ensure the patient's progression through the continuum of care in a manner that achieves the desired clinical outcomes and effective resource management. More specifically, this manager is responsible for ensuring their teams' assigned patient case load is proactively managed to prevent unnecessary hospital arrivals. In addition, they will be measured by re-admissions of the subset of their patients. This role also promotes consistent application of effective processes and clinical service accountability. The incumbent works closely with market clinical and operational leadership to support the ongoing improvement of case management operations.
The Manager, Intensive Community Complex Care (ICC) directly manages a regional team that will include multiple areas and ICCMs. As a member of the Complex Care Team, this role is responsible for high-value care across multiple regions, to serve as coach, mentor/trainer to all members of care management team, giving guidance in best practices, troubleshooting to optimize the value of care in hospital and community setting.
ESSENTIAL JOB DUTIES/RESPONSIBILITIES
- Manages a team of Intensive Community Care Managers (ICCMs) to deliver on reducing the number of hospital arrivals for the patients within their care and for a period of time post program.
- Actively involved in the full employment cycle of direct reports, including but not limited to participation in the recruitment process, talent and performance management, day-to-day oversight of staffing/scheduling needs, weekly time, time off approval, team vacation coverage plan, active nursing license verification, problem solving, exit interviews and termination/counseling decisions.
- Provides structure and assures consistent execution of the Care Management Process (CMP), including Case Management (CM) and Disease Management (DM) plans. CMP is a collaborative model including patients, manager, social workers, PCPs, specialists, other providers/practitioners and caregivers. Coordinates care with PCPs, specialists and ancillary teams across the market to drive the results of keeping patients out of the hospital
- Advocates for and assists Intensive Community Care Manager with ensuring patients achieve optimal health, access to care and appropriate utilization of resources to keep patients out of the hospital unnecessarily.
- Consults with and influences physicians, specialists, and other providers to refer patients to care management for assessment, planning, implementation, coordination, monitoring and evaluation to develop an individualized care plan prior to hospitalization which can result in decreased admissions and hospital sick days. Aids in identifying areas of opportunities at the PCP, center, and market level.
- Serves as the resident CM and DM "expert" to support Intensive Community Care Managers (ICCMs) needs for market specific education.
- Facilitates medication reconciliation and adherence education; disease education and coaching; advance directive/end of life discussions and referral/authorization management with Intensive Community Care Managers (ICCMs) as needed.
- Educates and supports Intensive Community Care Managers (ICCMs) at appropriate and repeated intervals, assesses and reassesses the patient's progress utilizing telephone and other technologies and resources. Depending on the progress, urges appropriate interventions to obtain optimal outcome.
- Monitors and manages clinical and financial coordination of treatment plan of assigned patients to ensure timely, cost-effective, individualized service delivery to prevent unnecessary hospital arrivals, ensure patients are on their appropriate medication, and receive appropriate coordinated specialty care as needed.
- Performs active ICCM duties to a small caseload as needed based staff availability. Provides support for catastrophic cases within clinical support group. .
- Assists with development and implementation of case management policies, processes, and standard operating procedures (SOPs) as appropriate.
- Precepts new Intensive Community Care Manager (ICCMs).
- Assists with quality audits and data analyses to identify opportunities for improvement.
- Identifies problems or any dissatisfaction experienced by patients or referring source and works to resolve them to a high degree of service excellence.
- Formulates, implements and evaluates educational strategies for staff, providing best outcomes for our patients and family members.
- Identifies and shares best practices to advance efficiency and performance.
- Assists with workflow efficiency improvement for clinical and operational practices.
- Facilitates inter-disciplinary rounds in conjunction with market, regional, and home office physicians and leaders for discussion of complex needs and follows up on action items.
- Monitors, reports out, and addresses areas of opportunities progress towards goals, KPIs, and daily actions of regional team.
- Works with Complex Care COE for development and implementation of best practices
- Consistently demonstrates efficient use of time and resources within established budget parameters, while actively participating in identification and implementation of cost saving strategies.
- Performs other duties as assigned and modified at manager's discretion.
KNOWLEDGE, SKILLS AND ABILITIES
- Strong business acumen in data analytics and fiscal skills to monitor and control costs and revenue
- Excellent verbal and written communication skills to effectively connect with diverse populations including physicians, employees, patients and their families
- Teaching abilities to conduct educational programs for PCP's, Chen Med staff, and tier one hospital staff
- Knowledge of care delivery capabilities along the continuum of care
- Superb interpersonal and critical thinking skills to work productively with all levels of the organization and to supervise the activities of a group of employees
- Resourcefulness to identify prompt and sustainable solutions to barriers in care delivery
- Leadership skills to direct others toward objectives that contribute to the success of the business unit Ability to supervise and train employees, to include organizing, prioritizing, and scheduling work assignments
- Ability to cope with stressful situations, manage multiple and sometimes conflicting priorities simultaneously
- Flexibility with schedule, including off-shifts, weekends and holidays to meet the needs of patients, families or staff
- Excellent knowledge of case management principles, healthcare management and reimbursement
- Excellent organizational and time management skills
- Proficient in Microsoft Office Suite products including Excel, Word, PowerPoint and Outlook, plus a variety of other word-processing, spreadsheet, database, e-mail and presentation software
- Ability and willingness to travel locally, regionally, and nationwide up to 30% of the time
- Responsible for ensuring direct report retain their active nursing license as appropriate
- Spoken and written fluency in English, bilingual preferred
- This job requires use and exercise of independent judgment
EDUCATION AND EXPERIENCE CRITERIA
- A valid, active Registered Nurse (RN) license in State of employment plus one of the following degree conditions is required: Bachelor's Degree in Nursing (BSN); OR
Associate degree in Nursing (ADN) with 2 years' home health, case management or discharge planning work experience; OR Bachelor's degree in a health-related discipline
- Compact license required if available in state.
- Minimum of five (5) years' clinical work experience
- Minimum of two (2) years' utilization review and/or case management, home health and/or discharge planning experience highly desired
- Basic Life Support (BLS) certification from the American Heart Association (AMA) or American Red Cross required w/in first 90 days of employment
- This position requires possession and maintenance of a current, valid Driver's License
- Case Management Certification through the Commission for Case Manager Certification (CCMC) or the American Association of Managed Care Nurses (AAMCN) preferred
- Hospital, healthcare setting experience is preferred
- Experience with psychological aspects of care desired
- Leadership experience in a healthcare setting highly desired (lead nurse, charge nurse, nursing supervisor, etc.)
PAY RANGE
$91,165 - $130,235 Salary