Posting Note: Please note: This position is looking for an individual with Payer Case Management experience. This individual will have experience managing a case management/clinical team in a payer setting.
Care coordination is the deliberate organization of patient care activities to facilitate the appropriate delivery of health care services. This position manages the activities of PCCN’s care coordination team, including RN Care Managers, Social Workers, and Care Navigators in coordination with department Supervisors. The Manager of Care Coordination oversees daily operations for the team: provides guidance, mentoring, and education to support and develop staff; maintains a reduced clinical case load working with children and their families to identify problems and develop goals and interventions to support a child’s health and well-being. The Manager of Care Coordination collaborates with the Chief Medical Officer and Director of Clinical Integration to develop programs to meet emerging needs of children, families, and staff and to support contractual obligations with payer partners. This position works independently and reports to the Director of Clinical Integration.
- Family-Centered care that focuses on the need of the child first and values the family as an important member of the care team
- Excellence in clinical care, service and communication
- Collaborative within our institution and with others who share our mission and goals
- Leadership that set the standard for pediatric health care today and innovations of the future
- Accountability to our patients, community and each other for providing the best in the most cost-effective way.
- a) Provides guidance, mentoring, and direction as appropriate for ongoing staff development.
- b) Plans, writes, recommends and implements approved procedures and guidelines to support the organizations policies, values and mission.
- c) Coordinates work activities of assigned staff to promote achievement of established goals, objectives, and outcomes.
- d) Provides team leadership, demonstrating strong, consistent, clear communication and serves as central point of information for team members.
- e) Coordinates with other matrixed departments, such as Marketing and Clinical Informatics.
- f) Works closely with the RN Informatics Manager to communicate workflows and align on system designs.
- g) Identifies and fosters care management system subject matter experts to be available for system testing for all supported workflows.
- h) Implements quality assurance processes to support a consistent patient and family experience
- i) Collaborates with Chief Medical Officer and Director of Clinical Integration on initiatives to improve quality performance against pre-defined gap in care and utilization metrics.
Education and Human Resource Coordination
- a) Participates in the employee selection process and makes hiring decisions with the Director of Clinical Integration. Has the authority to hire, terminate, advance and/or promote employees in coordination with the Director of Clinical Integration and Human Resources department.
- b) Evaluates performance of direct reports and completes performance appraisals.
- c) Develops care management staff through ongoing goal setting, training and performance feedback, in coordination with department Supervisors.
- d) Handles all aspects of employee complaints and/or grievances, including administering disciplinary actions and developing plans of action.
- e) Coordinates the orientation of new staff to the organization, department, and department policies and procedures.
Analyzes Department Data
- a) Evaluates departmental practices and protocols and looks for alternatives on an ongoing basis.
- b) Monitors the care management teams performance and productivity through tracking reports made available by the RN Informatics Manager, providing support and direction as needed to achieve departmental goals.
- a) Maintains professional competency by regularly participating in a variety of educational programs and in-services, reviewing relevant professional publications, participating in community based committees related to service line responsibilities, and/or participating in professional societies to ensure ongoing awareness of current methodologies, practices and philosophies as applied to the patient care population.
- a) Coordinates complaints/grievances from families and patients and serves as an escalation point for difficult cases.
- b) Communicates clearly in both written and verbal communications with all internal and external customers.
- c) Routinely provides excellent service in interactions with all internal and external customers.
- d) Responds to email within 24 hours or one business day.
- a) Administers complex portions of Health Risk Assessments (HRAs) with patients/families who may be eligible for PCCN’s care management services.
- b) Works with patient/family and other members of the care team to develop plans of care.
- c) Identifies and coordinates needed referrals for specialty care, behavioral health, community services and/or social work.
- d) Works closely with Care Navigators, assigning tasks and follow up to implement the plan of care and monitors progress.
- e) Conducts status meetings with patients/families as needed.
- f) Monitors and evaluates patient/family success with meeting established goals and (coordinates revision of care plans accordingly.
- g) Makes discharge from care management determinations based on goal completion.
- h) Escalates unresolved barriers to the Manager of Care Coordination.
- i) Maintains timely, complete and accurate documentation in compliance with regulatory policies and procedures.
- j) Supports initiatives to improve quality performance against pre-defined gap in care and utilization metrics.
- k) Leads interdisciplinary care team meetings, reporting on desired and actual patient health outcomes and facilitates discussion to create action plans as necessary.
- l) Creates or approves communications sent to interdisciplinary are team.
- Performs miscellaneous job related duties as requested.