Director of Care Management
GENERAL RESPONSIBILITIES:
Using principles of Patient Centered Medical Home (PCMH), the Director of Care Management will demonstrate professional clinical practice, excellent communication and analytical skills and outstanding customer service to promote and assist individuals in better managing their health through chronic disease education, wellness promotion and adherence to personalized care plans. The Director will promote coordination and integration of medical and behavioral health services by leading Care Management staff to engage patients as well as various other WYH staff to achieve effective continuity of care.
SPECIFIC RESPONSIBILITIES:
Management Duties
- Develop, implement and evaluate a Care Managment program that strives to improve the patient experience, that endeavors to improve the health of WYH patients and reduce the cost of care per capita of WYH patients
- Recruit, train and monitor competencies of staff members
- Provide day-to-day direction and supervison of Care Management staff
- Develop and monitor performance expectations for Care Management staff
- Assure compliance with NCQA PCMH recognition standards as it relates to the Care Management functions at WYH
- Participate in annual budget development for the department and
- Lead Care Management staff participation in performance improvement activities as requested
Care Management Practices
- Utilize evidence-based practice standards that address “the Triple Aim” , PCMH guidelines, and knowledge of Chronic Illness, to assure coordination of care for high acuity, complex patients receiving care at WYH
- Collaborate with providers/clinical teams to identify target patient population for care coordination based on electronic medical record reports, population health registry, lab/diagnosis criteria, and individual recommendations.
- Coordinate process for outreach to patients with care opportunities; link patients with cultural and community resources to facilitate referrals for needs identified, and assist with problem solving for social and financial barriers.
- Develop pre-visit planning protocols and assure that pre-visit planning acitivities are a vital part of the care coordination effort
- Develop workflows and manage the WYH transition of care efforts including hospital/ER discharge to ambulatory follow-up as well as other transitions in and out of the primary care setting.
- Champion the use of technology by Care Management staff to assist with all aspects of care: EHR documentation, disease registry, merging of templates per standing orders, using alerts to determine overdue care, Relevant data warehouse queries, service testing and or screening.
- Embrace and foster a culture of patient care safety as a means of compliance with local, state, and federal regulations (OSHA, NCQA, NYSDOH, HRSA)
- Foster and promote collaboration with all clinical disciplines represented within WYH to better address and meet patient needs.
- Assist, as needed, with direct patient care tasks when back up coverage is needed
Professional Expectations
- Demonstrates excellence in both internal and external customer service.
- Maintains required licensure/certification to remain current in her/his professional credentials
- Understands and is able to effectively communicate HIPAA compliance, corporate compliance and patient confidentiality.
- Adheres to the National Patient Safety Goals as defined by the Joint Commission and Whitney M. Young Jr. Health Center.
- Completes other duties as assigned.
MINIMUM QUALIFICATIONS:
Bachelors degree in Nursing with current NYS licensure and a graduate degree in a health care discipline. Minimum of five (5) years of experience in providing care management/nursing case management to vulnerable populations. At least two (2) years of management experience leading a care management/case management team. Demonstrated excellent customer service, good communication, and interpersonal skills. Proficiency with Microsoft Office suite and proficiency in utilizing care management/EHR applications.
PREFERRED QUALIFICATIONS:
Ten years of management experience in an ambulatory practice setting with patients with chronic conditions. Extensive experience in an ambulatory PCMH setting that delivers integrated primary care/behavioral health services. Prior experience in, and knowledge, of managed care requirements and other payer expectations of primary care provision including Value-Based Payment arrangements.
All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, status as a protected veteran, or any other legally protected status.