Manager Care Management North

Job Description

Facility: Mount St. Mary's Hospital

Shift: Shift 1

Status: Full Time FTE: 1.000000

Bargaining Unit: ACE Associates

Exempt from Overtime: Exempt: Yes

Work Schedule: Days

Hours:

Primary 8-4pm

Summary:

Responsible to direct, manage and lead the overall functions of the care management department to ensure consistent, effective and efficient site specific utilization review, medical management, discharge planning and care coordination for patients across our continuum. Accountable for achievement / success in achieving site specific/system wide utilization/discharge planning performance, productivity standards, fiscal/financial targets as well as select quality targets. Works closely with supervisor of social work and utilization review (UR) to ensure associates have adequate training and support to implement Standard Operating Procedures (SOPs).

Responsibilities:

EDUCATION

• Bachelors in Nursing, health related field
• Unrestricted NYS RN license
• Specialty certification preferred (i.e., CCM, CPC, CDIS, RNC, etc.)

Or

• Bachelors of Social Work (B.S.W.) from a school accredited by the Council on Social Work Education
• Specialty certification preferred (i.e., CCM, CPC, CDIS, RNC, etc.)

EXPERIENCE

• Three years care management/medical management leadership which includes direction/ oversight/direct reporting relationship for a clinical team or combination of experience and education that supports leadership role
• Demonstrated track record of success/accountable for site/system wide clinical, quality and financial results in an acute care environment

KNOWLEDGE, SKILL AND ABILITY

• Demonstrated leadership skills and team building with ability to lead and motivate others
• Excellent critical thinking skills, complex problem solving and analytical /statistical skills
• Systems and strategic management thinking with ability to effectively and efficiently implement and operationalize innovative/cutting edge programs, especially in context of high performing health systems, ACO methodologies and population health
• Extensive knowledge of medical management, utilization, discharge planning principles /practice as well as clinical pathways
• Extensive knowledge and fluency of NYS DOH, CMS, JCAHO standards, third party regulations and compliance standards
• Stellar interpersonal/intrapersonal relationships with executive, senior administrative and medical leadership teams
• Recognized and viewed as subject matter expert on care management, care coordination, disease management, discharge planning, utilization review for their respective site
• Active/valuable participant of the site's administrative team/council
• Active/valuable participant of systems initiatives on clinical operational effectiveness

WORKING CONDITIONS

• Routine travel between acute care facilities

ENVIRONMENT

• Normal heat, light space, and safe working environment; typical of most office jobs