Manager - Care Management

When you join the growing BILH team, you're not just taking a job, you’re making a difference in people’s lives.

The Manager of Care Management has overall responsibility and accountability for the ongoing management and implementation of BILHPN’s care management programs for eligible risk patients; which may include Post acute, Ambulatory, Care Transitions, Quality, Chronic Care or other innovative programs. The manager is a key collaborator in the development of population health management strategies, program development and implementation within the team he/she/they manage.

Essential Duties and responsibilities:

1. Recruits, hires, manages and evaluates care management staff, inclusive of Nurses, Social Workers, and other care management staff (eg. Patient Engagement Coordinator, Community Health Navigator). Works with BILHPN clinical excellence team and BILHPN Local Care Unit and Primary Care leadership to organize and assign the team to maintain adequate staffing and productivity/efficiency levels. Develops and implements competencies and provides ongoing education. (essential)

2. Aligns and Directs work of team to BILHPN strategic priorities in order to achieve clinical and financial program goals and related outcome measures as developed by the Director of Network Care Management and Clinical Excellence Leaders. (essential)

3. Jointly develops programs and/or approaches that ensure effective case management and smooth transition of patients between care settings. This may include working with hospital, post acute, and community care management representatives within and external to BILH. Also coordinates medical management and delegation activities with new provider groups to ensure compliance with agreements. Coordinates care management activities within risk unit and primary care offices to ensure programmatic integrity, specialty services and off site case management. (essential)

4. Oversees agreements with payers and provider groups to conduct case management using specified registries and web applications. Ensures that required performance measures are achieved and maintained. Works with PCPs to ensure appropriate coordination of care of identified risk patients / members. (essential)

5. Initiates mechanisms for working with representatives of payer organizations to achieve mutual goals of quality, cost effective care. Participates in developing responses to new contracts and contract changes. Develops a program for working with health plan nurse case managers. (essential)

6. Follows trends in care management of special populations or disease management of specified chronic illnesses. Recommends incorporation of programs to BILHPN Director of Network Care Management or Clinical Excellence Leaders required. (essential)

7. Has the authority to direct and support employees daily work activities. Has the direct responsibility to undertake the following employment actions: hiring, termination, corrective action and performance reviews. Direct Reports: More than 7 Indirect Reports: 1-5

9. Assists in planning, monitoring and/or managing budget in functional area of department.

Job Description:

Education:

Bachelor’s degree required, Masters Preferred
 

Licensure, Certification & Registration:

• Clinical licensure as a RN, or LICSW / LCSW
• Case Management Certification (CCM preferred)
• ACM or CCM certification preferred

 

Experience:

 

5-8 years related work experience required within Population Health, Ambulatory focused Care Management.

5 – 8 years related work experience required within ACO, and/or managed care or commercial payors.

1-3 years supervisory/management experience required.

 

• Skills, Knowledge & Abilities:
• Strong development, analytic and systems building skills.
• Must be facile with physician relations, developing systems and procedures, developing and operating a capitated managed care infrastructure, continuous quality improvement, human resources management and fiscal management.
• Excellent written and verbal communication skills.
• Must have a professional demeanor and the ability to deal with physicians, senior management, and local industry.
• Capable of serving as a spokesperson and leader of the integration process and communicate the vision to others in the community.
• A well-defined style that demonstrates confidence, maturity, self-motivation, high energy, collaboration, high intellect and leadership qualities.
• Excellent interpersonal skills, be an appropriate risk taker, politically savvy, diplomatic, able to deal with ambiguity, flexible, organized, results oriented, a hard worker, a quick study, good with details and have integrity.
• Ability to function as a facilitator who can further the organization to serve the evolving Network.
• Strong clinical background. Experience in managed care, community nursing, and outpatient case management, post acute care, quality measure gap closure, and disease management programs.
• Leadership experience in program and/or staff development.
• Advanced skills with Microsoft applications which may include Outlook, Word, Excel, PowerPoint or Access and other web- based applications. May produce complex documents, perform analysis and maintain databases.
• Working within EMR’s: Epic, ECW, OMR, Medi-tech, Athena, Arcadia

 

 

Pay Range:

$120,000.00 USD - $150,000.00 USD

The pay range listed for this position is the annual base salary range the organization reasonably and in good faith expects to pay for this position at this time. Actual compensation is determined based on several factors, that may include seniority, education, training, relevant experience, relevant certifications, geography of work location, job responsibilities, or other applicable factors permissible by law. 

As a health care organization, we have a responsibility to do everything in our power to care for and protect our patients, our colleagues and our communities. Beth Israel Lahey Health requires that all staff be vaccinated against influenza (flu) as a condition of employment.

More than 35,000 people working together. Nurses, doctors, technicians, therapists, researchers, teachers and more, making a difference in patients' lives. Your skill and compassion can make us even stronger.

Equal Opportunity Employer/Veterans/Disabled