- Develops, implements, and monitors care coordination services and interventions for for patients transitioning between healthcare settings.
- Hires, trains, supervises, and monitors the work of Care Coordination staff who are assigned to transitional care activities. This includes reviewing documentation to ensure that patient screenings, care plans, and progress notes maintained by the staff meet departmental and regulatory standards and are completed within required timeframes.
- Prepares staffing plans and schedules as well as performance appraisals and approves hiring, and termination/discipline decisions in accordance with organizational policies.
- Coaches, supports and acts as a resource to staff.
- Demonstrates the ability to find information necessary to make solid clinical and business decisions, and communicates to care coordination teams
- Determines data necessary to drive operational processes and analyzes and interprets data to drive performance improvement efforts to optimize productivity and outcomes.
- Refines and improves processes/workflows/ policies and procedures to meet the evolving needs of patient populations, the healthcare team, and the healthcare system using employee and patient satisfaction as well as financial, operational and outcomes data.
- Promptly investigates issues/complaints and resolves, when possible. Ensures solutions are consistent with contractual agreements, department objectives, policies and procedures, and regulatory requirements.
- Develops methods for evaluating staff performance and measuring and monitoring departmental objectives and reports results.
- Participates in special projects and performs other duties, as required.
- Fosters an exceptional teamwork environment with interdisciplinary colleagues; coaches staff in building strong team dynamics.
- Demonstrates the values and service standards of the organization.
- Must have a Bachelor’s in Nursing.
- Licensure as Registered Professional Nurse in New York with current registration.
- Minimum of three to five years of clinical nursing experience. Five years or more of supervisory, management or comparable experience in a related setting and program function. Minimum of three to five years’ experience in care management/coordination for a health plan or hospital. Experience in team leadership.
- Understanding of health insurance including Medicare, Medicaid, and managed care requirements and value based payment models.
- Excellent verbal and written communication, interpersonal and team building skills.
- Self-directed, creative, good understanding of inpatient and ambulatory health care systems.
- Negotiation and conflict management skills; creative problem solving and leadership; change management, productivity, organizational and time management skills; able to apply critical thinking and clinical expertise toward achievement of specific outcomes through others; previously demonstrated ability to effectively communicate and to foster strong collaboration with management, co-workers, peers, subordinates, physicians, nursing, and ancillary departmental support staff.
- Proficient in Microsoft Office Word, Excel and PowerPoint.
- Master’s in Nursing, Social Work, Public Administration, Business Administration or related field preferred.
- Formal leadership experience in a position of comparable scope, in clinical care management/coordination at a health plan, home care agency or hospital.
- Experience in project management and evaluation, quality and performance improvement methodologies, and staff and patient education.
- Health plan care management/coordination experience desirable.
- Membership in care management/ coordination and/or related specialty professional organization desirable.
- Certification in Case Management, American Board of Quality Assurance and Utilization Review Physicians, Inc. (ABQAURP) or Certified Professional Healthcare Quality (CPHQ) preferred.
Job ID: 1047091_RR00024018