Manager Care Management- Sheboygan

Department: 11200 AMC Sheboygan County - Case Management Status: Full time Benefits Eligible: Yes Hours Per Week: 40 Schedule Details/Additional Information: Day shift Monday-Friday, intermittent on call support Pay Range $47.50 - $71.25 Major Responsibilities: Provides management oversight of the daily operations of the care management and social work programs at the assigned site(s). Approves and monitors staff schedules, paid time off, and time cards to ensure continuity of services. Monitors proficiency of each site CM/SW staff and includes action plans to improve deficiencies, meet regulatory requirements, and drive efficiencies. Responsible for team building and conflict resolution. Facilitates performance improvement activities for the care management program; assists to establish measures, performance targets, and benchmarks to drive achievement of established goals and achieve efficiencies of processes. Collects, analyzes, and reports data to measure and identify the effectiveness of care processes and variations from standards and expectations. Analyzes data and information to discern root causes of performance gaps using key data and reports. Identifies and discusses overall and individual physician trends related to care management activities with Director of Inpatient Care Management Operations, Physician Advisor and site Medical Staff Leadership as appropriate with a documented improvement plan to include strategies and educational needs identified. Regularly reviews individual site successes and improvement opportunities with the Director of Inpatient Care Management Operations, site leadership and other key stakeholders. Serves as an internal consultant on Care Management opportunities. Acts as an expert resource for care management program, including evaluation of challenging cases, intervening with physicians when necessary, meeting with patients and families, dissemination and interpretation of key regulatory requirements and changes, etc. Consults, communicates, and organizes key ongoing education, serves as a supportive member of site UM Committees, and/or other site meetings as appropriate. Participates in multidisciplinary cross functional efforts to ensure high quality, cost effective coordinated care. Works collaboratively with Physician Advisor(s) on challenging cases, removing barriers to discharge. Accountable for site care management/social work budgets as assigned. Develops and recommends operational and capital budgets and controls expenditure within approved budget objectives. Ensures the care management/social work program operates within compliance of CMS, OSHA, Accrediting Organizations, and established care management practice standards and code of ethics. Collaborates with Compliance to ensure care management/social work program meets all state and federal guidelines. Responsible for orientation, and ongoing competency assessment of CM/SW staff in collaboration with the Director of Inpatient Care Management Operations. Responsible for personal professional growth. Participates in professional organizations, maintains license and certification as required, maintains effective working relations with both internal and external customers. Maintains required competencies and assumes responsibility of personal development and maintenance of ongoing workshops, conferences, and/or in-services and maintaining records of participation. Performs human resources responsibilities for staff which include interviewing and selection of new employees, promotions, staff development, performance evaluations, compensation changes, resolution of employee concerns, corrective actions, terminations, and overall employee morale. Develops and recommends operating and capital budgets and controls expenditures within approved budget objectives. Responsible for understanding and adhering to the organization's Code of Ethical Conduct and for ensuring that personal actions, and the actions of employees supervised, comply with the policies, regulations and laws applicable to the organization's business. Licensure, Registration, and/or Certification Required: Registered Nurse license issued by the state in which the team member practices, or Social Worker license issued by the state in which the team member practices and RN or SW: Accredited Case Manger (ACM) or SW (ACM) certification issued by the American Case Management Association (ACM) needs to be obtained within 1 year, or RN or SW: Certified Case Manager (CCM) issued by the Commission for Case Manager Certification (CCMC) needs to be obtained within 1 year, or RN: Nursing Case Management (RN-BC) certification issued by the American Nurses Credentialing Center (ANCC) needs to be obtained within 1 year, or SW: Certified Social Worker in Health Care (C-SWHC) issued by National Association of Social Workers to be obtained within 1 year Education Required: Bachelor's Degree in Nursing or Master’s Degree in Social Work Experience Required: Typically requires 5 years of experience in a relevant clinical setting. Includes 1 year of supervisory experience in a Care Management Leadership role. Knowledge, Skills & Abilities Required: Master of Nursing Administration, Master in Health Care Administration or related field preferred. Ability to prioritize and organize work. Ability to travel and work across multiple sites as assigned (IL or WI) Effective communication skills. Utilization of critical thinking in timely decision making. Knowledge of MS Office products. Demonstrates leadership skills. Knowledge of Medicare A and B guidelines. Knowledge of Managed Care programs/requirements/implications. Knowledge of Conditions of Participation for Discharge Planning. Knowledge of requirement elements of Utilization Management program, including support of the UM Plan. Knowledge of Regulatory environment. Ability to work autonomously and respond to multiple requests effectively. Physical Requirements and Working Conditions: Must be able to sit for approximately 50 percent of the workday; stand and walk for the equivalent of several blocks at a time. Must lift up to 10 lbs. continuously, up to 20 lbs. frequently, and up to 50 lbs. occasionally. Manual dexterity required for operation computer and calculator. Visual acuity required to facilitate review of written documents/computer screens, medical records, and to record information accurately. Clear oral communications and hearing acuity required for receiving instructions and converse on standard telephone. Functional speech and hearing to allow for effective communication of instructions and conversation over the telephone. Exposed to normal office environment; including usual hazards related to operating electrical equipment. Operates all equipment necessary to perform the job. This job description indicates the general nature and level of work expected of the incumbent. It is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities required of the incumbent. Incumbent may be required to perform other related duties. Our Commitment to You: Advocate Health offers a comprehensive suite of Total Rewards: benefits and well-being programs, competitive compensation, generous retirement offerings, programs that invest in your career development and so much more – so you can live fully at and away from work, including: Compensation Base compensation listed within the listed pay range based on factors such as qualifications, skills, relevant experience, and/or training Premium pay such as shift, on call, and more based on a teammate's job Incentive pay for select positions Opportunity for annual increases based on performance Benefits and more Paid Time Off programs Health and welfare benefits such as medical, dental, vision, life, and Short- and Long-Term Disability Flexible Spending Accounts for eligible health care and dependent care expenses Family benefits such as adoption assistance and paid parental leave Defined contribution retirement plans with employer match and other financial wellness programs Educational Assistance Program Note: Eligibility for programs listed above may depend on your FTE or status (e.g., full-time, part-time, per diem, temporary, etc.); please ask a Recruiter for more information during an interview. About Advocate Health Advocate Health is the third-largest nonprofit, integrated health system in the United States, created from the combination of Advocate Aurora Health and Atrium Health. Providing care under the names Advocate Health Care in Illinois; Atrium Health in the Carolinas, Georgia and Alabama; and Aurora Health Care in Wisconsin, Advocate Health is a national leader in clinical innovation, health outcomes, consumer experience and value-based care. Headquartered in Charlotte, North Carolina, Advocate Health services nearly 6 million patients and is engaged in hundreds of clinical trials and research studies, with Wake Forest University School of Medicine serving as the academic core of the enterprise. It is nationally recognized for its expertise in cardiology, neurosciences, oncology, pediatrics and rehabilitation, as well as organ transplants, burn treatments and specialized musculoskeletal programs. Advocate Health employs 155,000 teammates across 69 hospitals and over 1,000 care locations, and offers one of the nation’s largest graduate medical education programs with over 2,000 residents and fellows across more than 200 programs. Committed to providing equitable care for all, Advocate Health provides more than $6 billion in annual community benefits. This is Transformation One shared purpose brought us together. Now, as one of the 10 largest not-for-profit, integrated health systems in the United States, our combined strength and stability drives us forward. Starting with You Caring for nearly 3 million people has inspired a transformation. One in which the patient’s experience guides our vision and empowers us to offer new possibilities in our communities. Reshaping Access What is access? It’s offering more sites of care than any other health system in the Midwest. But there’s a new frontier. Access is exploring the latest technologies to deliver care to patients exactly where they are and exactly when they need it Inspiring Professionals With our dynamically inclusive workforce and strong connections to the places where we live and work, we’ll touch more lives and contribute to stronger and more vibrant communities. Transforming Care We’re redefining the standard for care with world-class doctors and caregivers, innovative solutions, outstanding outcomes, and leading-edge research and clinical trials. Combined, Advocate and Aurora are recognized for clinical excellence in: Cardiovascular Care Neurosciences Gynecology Oncology Pediatrics Primary Care Neurology Geriatrics Trauma Care