Manager: Case Manager of Population Health

Washington, DC
Jan 12, 2021
Jan 14, 2021
Full Time
Job Description* Job Summary * Responsible for assisting with implementation, integration and operational direction of the case management program within MedStar Family Choice (MSFC) through organizing, directing, assessing and evaluating a clinical system that manages cost and quality patient care outcomes. Facilitates the continuum of care, works collaboratively with interdisciplinary staff, both internal and external to the organization. * Minimum Qualifications * Education/Training * Valid RN license in the State of Maryland; Bachelor's degree preferred. * * Experience * 3 years case management experience; 5 years diverse clinical experience; 2 years supervisory experience. * * License/Certification/Registration * Valid RN license in the local area serving (State of Maryland and / or District of Columbia). CCM (Certified Case Manager) required. * Active CCM (Certified Case Manager) or CCM within 12 months required. * * Knowledge, Skills & Abilities * Effective verbal and written communication skills. Ability to follow verbal and written instructions. Proficient with Microsoft Office applications especially Word, Excel and PowerPoint. Ability to enter and retrieve information using a PC. Working knowledge of various computer software applications. Knowledge of current trends in health care delivery and population management. Knowledge of NCQA, HEDIS, InterQual and local regulatory guidelines preferred. * Primary Duties and Responsibilities * Acts as a liaison between IS and the clinical team to identify workflow / system issues and resolutions. Uses technology to enhance decision making and effectiveness. * Assists staff members with setting personal and educational goals and objectives to enhance their professional development. Develops and implements education programs to coordinate staff development and training needs both for software and clinical training issues. * Assists with identifying annual departmental goals and assists with the development of the annual UM plan and UM appraisal. * Assists with the development of department goals, objectives, policies, procedures, and performance and productivity standards in collaboration with the Director. Ensures compliance with policies and procedures and governmental and accreditation regulations. * Conducts monitoring of compliance of Case Management, Disease Management and Utilization Review standards, as per MSFC policies and procedures. * 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. * Contributes to the development, review, revision and implementation of disease management programs. * Demonstrates behavior consistent with MedStar Health mission, vision, goals, objectives and patient care philosophy. * Demonstrates skill and flexibility in providing coverage for staff. * Identifies and researches case management issues that impact patient care. Reports review findings to Director of Case Management and Physician Advisor/Medical Director when appropriate. Coordinates review determinations and notifications. * Leads staff meetings, work groups etc, as assigned. Addresses issues impacting MSFC with community agencies and providers. Delivers updated information back to CM staff. * Maintains current knowledge about and acts in accordance with procedures regarding member confidentiality, principles of consent, and Advanced Directives. * Maintains current knowledge of benefits, claims, and enrollment issues. * Manages daily error log from the UM software. Makes corrections in system in order for authorizations to travel to claims vendor. Educates staff regarding documentation issues and implements corrective action plans when necessary. * Performs other duties as assigned. * Provides backup support to Director as required. * Provides ongoing individual coaching and support to staff and acts as a resource for clinical, social, utilization and appeal review issues as they relate to case management. Meets regularly with department members to enhance communication and facilitate implementation and progress toward program objectives. * Runs monthly reports and collaborates with the Director to analyze monthly monitoring of LOS, Days per 1000, readmissions, physician denials, denial rates at acute facilities, and other reports as required by MSFC Case Management. * Selects, trains, orients and assigns department staff. Assists with the development of performance standards, evaluates performance, and conducts performance management planning. Initiates or makes recommendations for personnel actions. Maintains ongoing communication with subordinates to review progress, provide feedback, discuss new developments, and exchange information. About MedStar Health MedStar Health is dedicated to providing the highest quality care for people in Maryland and the Washington, DC, region, while advancing the practi