CTO RN Supv Care Management

Works collaboratively with the Clinical Director to assist with implementation, integration, and operational direction of Care Management within the Care Transformation Organization. Facilitates the continuum of care, works collaboratively with interdisciplinary staff, both internal and external to the organization. Supervises team of lead care managers and care coordinators who coordinate care for at risk Medicare Fee For Service beneficiaries in accordance with the goals and requirements of the Maryland Primary Care Program. Primary goals include provision of longitudinal and episodic care management; facilitating timely access to care, use of alternative care outside traditional office visit, and connection to services for patients who may benefit from behavioral health services and/or social service organizations. Assists the CTO Clinical Operations Manager in managing daily operations of the care coordination team with the goal of maintaining adequate staffing levels and efficient workflow. Acts as a resource and mentor to care managers, care coordinators, and interdisciplinary care team. Performs face-to-face and telephonic care management duties in medical practice and office settings.
Education

• Associate's degree in Nursing; required and
• BSN preferred

Experience

• 5-7 years Diverse clinical experience.for utilization management (UM), for case management (CM), 3 years CM experience required and
• Leadership experience preferred

Licenses and Certifications

• Valid RN license in Maryland; required and
• Certified Case Manager (CCM) certification preferred

Knowledge, Skills, and Abilities

• Ability to use computer to enter and retrieve data.
• Working knowledge of Microsoft Word, Excel, and PowerPoint applications.
• Effective verbal and written communication skills.
• Must be able to run and analyze departmental productivity reports.
• Excellent interpersonal skills required.

Contributes to the achievement of established department goals and objectives and adheres to department policies, procedures, quality standards, and safety standards. Complies with governmental and accreditation regulations.

Provides leadership, instruction, supervision, and direction to associates providing care management services in the Care Transformation Organization (CTO). Assists with the selection, training, orientation, and assignments of the department staff. Assists with the development of performance standards, and evaluation of associate performance. Initiates and provides recommendations for personnel actions. Maintains ongoing communication with associates to review progress, provide feedback, discuss new developments, and exchange information. Assists in assessing staff professional development and training needs. Identifies training needs related to the clinical software system (data entry / documentation) and programs or processes within the CTO. Implements a plan for training based on identified needs.

Provides support to Director's responsibilities and deliverables. Provides coverage for the Director and associates as required.

Actively develops and manages care management programs and develops individualized plans of care according to CTO guidelines and other regulatory obligations.

Performs care management services in the practice and/or telephonically which includes: assessment, planning, coordinating, implementation, and evaluation. Monitors for timely provision of services. Assists hospital discharge planners and other referral sources with discharge planning.

Acts as an advocate while assisting MDPCP beneficiaries to coordinate and gain access to medical, psychiatric, psychosocial and other essential services to meet their healthcare needs.

Completes applications for medically necessary services and equipment.

Monitors for timely provision of services. Assists hospital case management staff with discharge planning. (Utilization Management (UM) area).

Serves as a point of contact to support departmental workflows, processes, procedures, SOPs (Standard Operating Procedures), operations, productivity standards, and regulatory requirements (i.e. CMS). Maintains current knowledge of benefits and enrollment issues in order to accurately coordinate member/provider services.

Communicates patient needs with Providers and practice staff in a courteous and helpful manner at all times. Facilitates ongoing communication and collaboration amongst practice and care team. Regularly communicates with practices to review programmatic changes, identify opportunities, implement new initiatives, and address concerns.

Carries patient caseload commensurate with department needs.

Responsible for day-to- day operations of the department, which may include preparation of daily coverage assignments and adjustments as needed. Receives, reviews, processes time off requests and updates staffing calendar. Acts as liaison between IS and the clinical team to identify workflow/system issues and resolutions.

Runs productivity reports, collaborates with the Director to analyze reports, and schedules regular meetings with associates to review reports and progress toward goals.

Prepares department meeting agendas and co-leads meetings. Assists in preparation and/or review of meeting minutes. Participates in meetings, serves on committees and represents the department in community outreach efforts as appropriate. Participates in multidisciplinary quality and service improvement teams as appropriate.

Assists staff in identifying ways to improve the efficiency of the department. Motivates staff to assist with innovations and member and provider engagement. Provides regular feedback on the progress made toward reaching departmental goals.

Serves as the care management subject matter expert and point of contact for partner practices and MedStar stakeholders.

Demonstrates behavior consistent with MedStar Health mission, vision, goals, objectives and patient care philosophy.