The Manager of Care Management, under the direction of the Director of Care Management is responsible for the Care Management program for both Dean Medical Group and Dean Health Plan. The incumbent manages and coordinates the daily activities of the Care Management Program to ensure appropriate staffing resources. The manager monitors and evaluates operations and process to assure optimal efficiency and effectiveness, and identifies opportunities to implement best practice approaches and innovations to better address patient and member needs. Maintains vendor relationships and monitors outcomes. The goal is to maximize quality outcomes across the care continuum for the patients and members we serve through the most appropriate utilization of system resources while providing an exceptional experience. The Manager is responsible for continual staff development utilizing call monitoring and case auditing and development of training opportunities. Tracks and trends program success. Meets and exceeds NCQA and PCMH standards.
1. In collaboration with the Director Care Management, prepares, monitors, meets and effectively manages departmental, human resources and operating budgets.
2. Recruits, hires, trains and retains staff, providing leadership and oversight. Set direction and objectives and provide feedback.
3. Manage daily activities of the team, including RN Care Managers, RN Case Managers, Care Coordination Specialists, Care Management Specialists and Social Workers to ensure program objectives are met.
4. Establishes guidelines for caseloads and monitors productivity.
5. Assist with the development and maintenance of case and disease management programs; and adherence of programs and processes to NCQA, CMSA Case Management Standards and other applicable government regulations and quality initiatives.
6. Responsible for development and maintenance of policies and procedures and workflows, focusing on process standardization, adhering to evidence based medicine and best practice and assuring compliance with regulatory and accrediting standards. (eg NCQA)
7. Conduct regular team meetings.
8. Assists and participates in meeting system initiatives and program goals.
9. Establishes and maintains positive communication and professional demeanor with internal and external customers at all times.
10. Analyze data to track and trend productivity and quality and outcome metrics. Identify quality and performance improvement opportunities to implement best practice approaches and introduce innovations to address patient/member needs across the continuum of care.
11. Responsible for meeting and exceeding requirements related to accrediting bodies, state agencies, employer groups and value based contracts.
12. Performs other duties as assigned.
1. Unrestricted, State licensure as a Registered Nurse in the State of Wisconsin.
2. Bachelor's Degree in Nursing or other healthcare related field
3. Five years of clinical experience in an acute care hospital, long term care facility, home health/hospice, clinic or physician practice setting
4. At least 1-3 years Case Management experience
5. At least 3 years of progressive supervisory/management experience
6. Knowledge of Standards of Practice for Case Management.
7. Knowledge and experience with predictive modeling
8. Knowledge and experience with motivational interviewing techniques.
9. Demonstrated management skills and leadership qualities including time management, verbal and written communication skills, listening, problem solving, decision-making, prioritization, delegation and work organization.
10. Demonstrated ability to interact with members of the health care team, health plan partners, community agencies, patients and families with diverse opinions, values and religious and cultural beliefs.
11. Demonstrated ability to analyze and interpret data.
12. Ability to perform duties with minimal supervision and work well as a part of a team within an integrated delivery network.
13. Experience with and proficiency in Microsoft applications (Word, Excel, Outlook, PowerPoint).
14. Valid driver's license and person, reliable vehicle required for work related travel to fulfill responsibilities.
1. Complex Case Management (CCM) Certification or Chronic Care Certification
2. Motivational Interviewing Certification
3. Experience with NCQA or other quality certification programs
4. Previous experience with population health risk stratification models.
5. Previous experience with EPIC electronic health record software.
Essential Physical Functions:
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
1. This is primarily a sedentary position.
2. Ability to hear and converse on the phone and in person.
3. Ability to see fine print and to use the computer for extended periods of time.
4. Ability to perform fine motor tasks, such as when writing, or performing computer or phone tasks.
5. Ability to safely drive a personal vehicle on a daily basis and comply with the Driver/Fleet Safety Program.
About SSM Health Dean Clinic-
Based in Madison, Wis., Dean Clinic consists of a network of more than 60 clinics in south-central Wisconsin. Our more than 500 physicians provide primary, specialty and tertiary care in the clinics as well as eye care through our Davis Duehr Dean locations. Dean Clinic also offers urgent care services and operates outpatient surgery centers. Dean Clinic joined SSM Health in 2013. lol
You’ve known us as many names throughout St. Louis, and now, we’re bringing our hospitals, doctors, home care and other services together under one name – SSM Health. With seven hospitals, 350+ physicians, more than 40 physician locations and 12,000 employees, we are part of something bigger and better. We’re connected to a wealth of resources, expertise and advance technology to help you, your fa...mily and our community live long, healthy lives.
We’ve grown and changed a lot over our 143-year history. Our name may be changing but our mission remains the same