DescriptionPOSITION SPECIFICSTitle: Manager - Continuum of Care FTE: 1.0 FTE (40 hours/week) Schedule: Monday - Friday 8:00am - 4:30pm Holiday Rotation: NoneWeekend Rotation: NoneOn Call Requirements: NonePOSITION SUMMARYThe Manager of Continuum of Care coordinates the design, development, implementation, and monitoring of the organization's case management services and the Medicare and MA Utilization Review Program. Manages clinical and support staff in the performance of medical management functions, including case management, inpatient discharge planning, and Medicare and MA utilization review. Functions as the internal resource on issues related to the appropriate utilization of patient care resources, coordination of care across the continuum, and Medicare/MA utilization review and management.The Manager works collaboratively with SPH leadership, clinical directors, physician leaders, and other key stakeholders to maximize the quality of care and the patient experience, while also addressing the cost effectiveness of care.POSITION TECHNICAL RESPONSIBILITIESCore Manager
- Provides general oversight and coordination of daily operations of one or more departments.
- Assumes leadership role in establishing and achieving department goals.
- Assists in the development of new services lines and/or programs.
- Prepares project specific reports.
- Accomplishes daily department objectives by managing staff; planning and evaluating department activities. Directly oversees and addresses daily operational needs, typically for multiple cost centers.
- Reviews, analyzes, develops, and implements departmental workflow processes to increase efficiency, accuracy, and to decrease re-work.
- Assists with the development of policies, procedures, and productivity standards.
- Conducts daily rounds on team members to ensure optimal workflow and addresses daily staffing needs.
- Addresses departmental staffing assignments daily, ensuring optimal workflows are implemented. Evaluates staff workloads to ensure equitable distribution of work, and to determine appropriate staffing levels.
- Responsible for addressing human resource needs (interviewing, hiring, training and development, annual evaluations, etc.).
- Sets goals for individual team members that are in alignment with the department's and organization's goals. Holds personnel accountable for all activities outlined in their job descriptions, Service Excellence Standards, and other organizational requirements. Trains and onboards new hires to make sure they understand their roles. Communicates job expectations. In consultation with supervisor, coaches, counsels, and applies corrective action to employees as needed.
- Approves payroll for assigned team members.
- Works directly with staff to maintain compliance with external regulations and internal policies.
- Works directly with staff to maintain quality service by enforcing quality and customer service standards, analyzing and resolving quality and customer service problems, and recommending system improvements.
- Actively reviews staff use of materials, equipment, etc. and provides feedback to staff to ensure best use of resources.
- Interprets and explains policies from leaders to staff. Functions as a liaison between physicians, administration, and staff.
- Participates in developing and monitoring assigned budgets. Analyzes budget reports monthly to identify and correct for variances. Identifies and implements cost containment programs to be fiscally responsible.
- Serves on organizational committees as assigned.
- Occasionally provides services at the staff level during periods of staffing instability.
Continuum of Care Department Management
- Works collaboratively with SPH and community partners to connect and coordinate services across the continuum (acute care, primary care, specialty care, long term acute care hospitals, sub-acute level of care, long term, case management and social work, post-acute providers, etc.) to optimize clinical outcomes and resource stewardship.
- Supports facilitation of a comprehensive, cohesive, and coordinated approach to the care of patients over time, in multiple environments and across the entire spectrum of healthcare services delivery at SPH.
- Supports the Director and other key stakeholders to ensure that strategies and tactics are identified and operationalized across the organization; ultimately leading to improvements in care coordination, especially for high risk and complex patients.
- Supports the provision of a multi-disciplinary forum with an SPH perspective to evaluate strategic and tactical issues related to the continuum, and pilots ideas for new methods of delivering care (partnerships with senior centers to address the healthcare needs of the frail elderly, etc.).
- Studies and assists in the development of best practices for managing post-acute patient care.
- Studies and analyzes the financial and clinical services' impact of current continuum care practices.
- Works with leaders in case management, social work, SNF partners, and post-acute providers to assess current resources and expertise. Then with the assessment, reimagines and deploys resources across the continuum that decreases care fragmentation and enhances care understanding for all patients.
- Functions as the subject matter expert on care coordination evidence and innovation.
- Manages patient concerns/grievances related to care coordination.
Medicare and MA Utilization Review (UR) Program
- Assures the organizational UR Program is compliant with CMS requirements for Hospital Condition of Participation.
- Ensures that Medicare / MA utilization functions are completed as described in the UR Plan.
- Manages the Utilization Review Committee and the maintenance of the committee's work products.
- Serves as a technical expert and internal resource to assist in determining admission status and documentation standards.
- Interprets federal regulations and provides recommendations for department and hospital compliance.
- Develops and maintains management information systems to support analysis and reporting on UR functions and systems.
- Provides interpretation and analysis of UR-related data.
POSITION REQUIREMENTS Education:
- Required: Bachelor's Degree in Nursing or Social Work.
- Preferred: Master's Degree in healthcare, social work, business administration, or healthcare-related discipline.
Experience:
- Required: Experience in a hospital or clinic setting. Experience interpreting healthcare regulatory standards. Experience in case management and discharge planning.
- Preferred: Experience in utilization review.
Licenses and Registrations:
- Required: Current State of Wisconsin licensure as a Registered Nurse or licensed Social Worker.
- Preferred: None
Certification(s):
- Required: None
- Preferred: American Case Management Association (ACMA) Case Management certification.
BENEFIT SUMMARY
Competitive health and dental insurance options Flexible paid time off to balance work and life Retirement plan with immediate vesting and employer match Free membership to our state-of-the-art fitness facility Generous tuition reimbursement Employer provided life and disability insurance Free parking at facility#IND101