Provides leadership to Care Management RNs, Social Workers, and support staff to accomplish the operational functions and performance goals of the department, which include efficient patient throughput, safe and effective care transitions, and compliance with payer and regulatory requirements.
- Schedules team members so department is adequately staffed and patient needs are met.
- Monitors and adjust staffing to achieve productivity targets and accomplish essential work functions of department.
- Adjusts staff workloads to meet demand and ensure work is accomplished in a timely manner.
- Monitors expenses against budget and plans proactively for departmental costs and charges. Works with director to develop department budgets.
- Effectively uses managerial tools and software (e.g. Kronos, Workday, Premier, Lawson, Webnow).
- Interviews and hires staff that are competent and will assist with meeting department goals.
- Trains and develops staff to ensure their work is of high quality and aligned with departmental, regulatory and payer requirements.
- Evaluates staff performance fairly and provides meaningful feedback on progress towards performance goals..
- Observes and coaches staff as they perform their work to give real-time feedback.
- Engages staff in department, hospital, and CHI St. Joseph Health goals and results. Works with staff members to develop and achieve their own performance goals.
- Provides expertise in problem-solving for difficult patient issues.
- Knowledgeable in all aspects of Utilization Management and Care Management, including CMS regulatory requirements, and ensures compliance.
- Demonstrates excellent communication and negotiation skills.
- Uses data to monitor and communicate department performance metrics.
- Identifies areas for improvement and participates/leads performance improvement activities.
- Possesses strong organizational skills. Able to prioritize and delegate to manage a challenging workload. Holds staff accountable to accomplish assigned work.
- Aligns with organizational goals and works collaboratively with direct reports, peers and hospital leadership to achieve results.
- Partners with payers and Revenue Cycle to improve financial performance and ensure payer processes and requirements are met.
- Works collaboratively with patients, families, physicians and community partners for care transitions.
Education / Accreditation / Licensure (required & preferred):
- Current unrestricted license as a registered nurse or social worker in state(s) of practice is
- Registered Nurse: Bachelor of Science in Nursing required; Masters of Science in Nursing
- Social Worker: MSW required.
Experience (required and preferred):
- Minimum 5 years clinical experience as Registered Nurse (RN) or Social Worker
- Minimum 2 years managed care or equivalent care management experience required.
- Minimum 1 year leadership experience preferred.