RN Manager, Care Management

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POSITION SUMMARY
The Manager of Care Management will supervise and direct all levels of Care Management team that includes RN Care Managers, Lead Care Management RN, Care Management Coordinators, Discharge Planners (DCP), Care Coordinators, and Care Management Educator. This position may also be asked to supervise and cover supervision for other management in the CM Department. These services include assessment of patients for level of care, appropriateness for admission or observation, HLOC transfers, discharge assistance, and follow up care as appropriate in collaboration with the ED care management team and Social Work Department. Care Management policies for this work initiated, reviewed and implemented by the Manager as needed.
This Manager role will also provide clinical supervision for scheduling, Kronos payroll, coaching/corrective action, and educational needs to ensure that the care management policies and processes are carried out for the organization. This role will oversee the electronic referral system, currently Ensocare, documentation of care management through Cerner Healthcare EMR including working with Clinical informatics (CIT), to develop or improve care management documentation, as well as handoff processes.
This position is responsible for overseeing post-acute providers, facilities and other types of community service providers as directed by the Director of Care Management. The Manager will assist with overseeing compliance policies and plan related to vendor networks to maintain a working relationship between MLK and individual network providers. Manager will identify opportunities to improve post discharge services to reduce readmissions and improve community health in collaboration.
Works collaboratively with other colleagues within the Population Health Program to support the entire Care Management Department. This role is expected to share in Care Management Leadership Call on a rotation basis as assigned by the Director for Care Management
ESSENTIAL DUTIES AND RESPONSIBILITIES

• Manages and supervises the IP Care Management RNs, Care Management Coordinators, Care Coordinators,
  Discharge Planners, and Care Management Educator to support the MLKCH Care Management services includes but not limited to assessments, transfers to higher levels of care, inpatient discharge needs, and follow up care by DCP team according to Care Management Department policies and procedures.
• Works in collaboration with the Director of Social Work Services and Street Medicine to support the Care Management Program as well as in support of the Population Health Program at MLKCH.
• Oversight of MLKCH compliance policies related to discharge planning and use of letters of agreement (LOA) with current/planned scope of post-acute partner networks including:
  • MLK-LA Skilled Nursing Facilities (SNF)
  • MLK-LA Home Health Professional Network (planning)
  • MLK-LA Palliative and Hospice Network (planning)
• Have oversight of assessing need for additional provider networks in collaboration with management given new clinical/social needs and ongoing revisions to the Population Health Strategy.
• Identify and vet potential post-acute service providers
• Participates in hospital committees and unit specific multidisciplinary conferences as well as staff meetings for the Care Management Department
• Models leadership and promotes professionalism to assist staff in developing priority setting, team work, and flexibility in support of the Care Management team and in community health activities.
• Holds clinical and non-clinical staff accountable for the performing initial assessments, identifying and documenting a discharge plan, and collaborating with the work team to ensure a safe patient discharge under the scope and standards for ACMA & CMSA standards.
• Responsible for the hiring process and identifying and recommending staffing needs with skill mix as appropriate to meet needs of the population.
• Manages payroll in Kronos; monitors overtime as well as attendance related to HR policy for time & attendance.
• Oversee a mix of clinical, operational and business projects including but not limited to ones used reduce readmissions, improve transportation services such as ambulance services, and other clinical services
• Work closely with and in partnership with ED Care Coordinators, ED Care Managers, Social Work, Transitional Care Navigator staff, and clinical staff to ensure that patients care transitions from MLK entities to post-acute network providers are seamless.
• Establish and monitor management metrics: quality, outcomes, productivity of staff work, financial, case volume/mix and provides scheduled reporting to the Director of Care Management.
• Design and coordinate formal and informal training for staff and providers regarding post-acute services care management services, and oversees the clinical education program executed by the Care Management Educator.
• Systematically and continuously evaluate and address internal and external customer concerns/ grievances
• Collaborates and coordinates services and joint meetings with Los Angeles County Department of Health Services Outpatient Clinic staff
• Collaborates and coordinates functional programs with MLKCH outpatient clinics to ensure smooth transitions to community healthcare for MLKCH patients.
• Collaborates with other Care Management Leadership to ensure adequate staffing and scheduling to support the functions of the transitional care team.

POSITION REQUIREMENTS

A. Education

• Bachelor degree in nursing required.

B. Qualifications/Experience

• RN Candidates must have five (5) years acute care hospital, health plan, and/or ancillary services required.
• Prior Supervisory or Management Experience in a clinical role required.
• RN license required
• CCM or ACM certification required within 2 years of hire.
• Basic Life Support (BLS) certification
• Workplace violence prevention annually.
• Direct patient care or care coordination, utilization, case/disease management experience a plus
• Experience with Medicaid/ Medi-Cal patients and government programs preferred
• Experience in clinical health informatics is preferred.

C. Special Skills/Knowledge

• Significant knowledge regarding health care provider organizations - acute and post-acute care facilities and providers
• Working knowledge of health plans and typical UM and medical management functions
• Able to navigate communication and decision-making across disciplines and provider types
• Clinical knowledge and the ability to assess situations in collaboration with multiple disciplines in order to arrive at a decision often in pressurized situations

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