Position Summary:  Responsible for assisting the Regional Director ICM/VP ICM in providing management of day-to-day operation and workflow of the acute care management team.  Builds strong partnerships and interfaces within ICM service lines, key physician, and nursing leaders to reach the goals and objectives of the ICM departments, which include achieving the highest quality of care coordination, discharge planning, utilization of appropriate resources, LOS/measurable outcomes, and accurate reimbursement.

 

Essential Functions and Responsibilities As Assigned:

1.  Provides management of operations, including assisting with performance management, resolving staff problems, providing orientation and training for new staff and providers, and ongoing education for the care management team.

2.  Assists the acute RN/SW care managers with the coordination of care management review activities to ensure that patients requiring referral care and/or services receive them in a timely manner.

        3. Assists in facilitating acute Care Management reports and utilizing tools (i.e. Pepper Reports, MHC Data Warehouse, LOS, Ensocare, OBRA, Cerner, Port Huron Data Repository) for reporting trends and identifying reporting trends and identifying opportunities for potential improvement in care management transition of care, LOS, Avoidable delays, Readmissions, post-acute transfers, or delays in discharge metrics.

                       4. Responsible for acute care management applications (i.e., Ensocare, ACMA Compass / ACTS modules, Cerner CM Module, etc.) tools at each subsidiary,                as well as educating staff on updates and changes.

5. Collaborates with RN/SW Care Management, providers, and nursing staff to facilitate daily LOS stay rounding.

       6. Communicates with MHC subsidiary leadership to support care management initiatives, ICM dashboard metrics, and key performance indicators (KPIs). 

      7. Collaborates with other hospital departments and/or community resources to promote cooperation and efficiency in providing patient's care management needs.

             8. Collaborates with the ICM leadership regarding acute care management problems, issues related to discharge delays, social determinants, placement                       issues, provider engagement, medically related issues, and potential quality of care issues.

             9. Serves as resource to staff in resolving complex discharge planning, referrals, and Avoidable Delay/LOS outcomes

           10.  Performs monthly CM meetings at subsidiary accountable for.

           11. Participates in monthly ICM UM Committee and Population Health meetings  

           12.  Monitors compliance with departmental policies and procedures. Performs monthly IMM/MOON audits and provides staff education on Patient Choice,                    CMS IMM/MOON Regulations, and develops action plans

     13.  Assists in maintaining budget and ordering departmental supplies/equipment purchases.

    14. Assists with annual goals/performance management assessments and performs staff evaluations, develops, and trains staff and participates in the staff hiring process Assists with ensuring quality, financial, and customer service objectives are met.

           15. Assists patients and their families/significant others to understand their rights under CMS guidelines related to admission status and discharge planning.

           16.  Ensures accurate, timely, and appropriate acute care management services, in compliance with all healthcare regulatory requirements and applicable                      state and federal laws.

            17.  May perform the functions of a care manager as needed.

            18.  Performs other related duties as required and directed.

Qualifications:

Required:

Current license in the state of practice as a registered nurse or social worker Bachelor’s degree in nursing from accredited educational institution, or actively pursuing degree and to be obtained within five years of accepting position, bachelor’s in health care or business administration or master’s social work (MSW)

·         Four years of acute RN/SW case management experience in an acute healthcare facility

·         American Case Management Certification (ACM) or obtain certification when eligible as defined by the Association Case Management Association, and maintenance of continuing education requirements.

·         Member of the American Case Management Association (ACMA)

 

Preferred: 

Master's degree in business or a health-related field Two years of experience in supervision

·         Experience in social work, utilization review, clinical documentation, critical care, or quality.

Basic Life Support (BLS) certification as a Healthcare Provider by the American Heart Association, American Red Cross or equivalent through the Military Training Network (MTN)

 

Knowledge, Skills, and Abilities:

 

1.      Ability to travel to various hospitals and locations, including patient care areas, conference facilities, System offices and other sites as requested.

Ability to work independently and provide sound judgement in interactions with the interdisciplinary team, patients, families, and payers.

3.      Ability to work with diverse teams and individuals, team player

Able to spend majority of time utilizing a computer, monitor, keyboard and mouse; ability to type. Adaptability, strong critical thinking skills, creative problem-solving skills, and ability to collaborate. Comfortable operating independently in a collaborative, shared leadership environment. Compliance with the Nursing Code of Ethics and Guide for Professional Conduct Customer-focused attitude and ability to work proactively and efficiently with appropriate urgency.

9.      Demonstrated leadership skills such as accountability, professionalism, decision-making, coaching, counseling, conflict resolution, discretion, diplomacy and tact.

Prioritization and organizational skills required. Ability to educate all members of the healthcare team related to care management. Strong knowledge and skills working with computerized hospital/health information management systems and software applications (i.e. Cerner, Paragon, Meditech, InterQual, etc.) and Microsoft Suite applications. High degree of interpersonal skills with ability to effectively communicate with physicians, nursing, families/patients, utilization management and internal and external customers.  Knowledge of care management standards of excellence and best practice.

14.  Maintains knowledge of applicable national care management standards, CMS rules and billing regulations related to Medicare, Medicaid, and commercial insurance

Possess a personal presence that is characterized by a sense of honesty, integrity, and caring with the ability to inspire and motivate others to promote the philosophy, mission, vision, goals, and values of McLaren Health Care. Project management and organization abilities necessary to work with an interdisciplinary team in identifying sources of data for efficient clinical, functional, service and cost outcome studies, and to work with a team of support personnel from multiple departments. Strong analytical ability to gather and interpret data to identify discrepancies, problems or issues, to determine compliance with regulations, policies and procedures and to apply sound judgment.

18.  Weekend, holiday, and evening coverage as per site requirements

Additional Information Schedule: Full-time Requisition ID: 24008115 Daily Work Times: 8-4 Hours Per Pay Period: 80 On Call: Yes Weekends: Yes