Hybrid Mgr Case Management OP en Wellstar Health System

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Work Shift

Day (United States of America)

Job Summary:

The Manager of Outpatient Case Management is is accountable for the direct day to day management of the outpatient case management staff under population health management. The manager creates a support structure within the department for achieving clinical and operational excellence and expected deliverables of the program in relation to CM efforts and program initiatives. These include managing the daily workflow and day to day operations of the embedded CM, telephonic CM, Complex social worker role and any other staff working directly under the OP CM program initiatives. The Manager will also have program compliance, program development in conjunction with the Population Health Management VP and AVP. Requires skill and leadership in managing the staffing and their training needs to meet the expected requirements of role. Track and trend program compliance. Collaborates with interdisciplinary teams including, but not limited to, physicians, nurse practitioners, PA's, and other department managers for Care Coordination and other service as it related to managing the continuum of care. Collaborates extensively with other members of the health care team to capture and provide data to guide performance

Core Responsibilities and Essential Functions:

Manages the OP Case Management Department activities to meet department and corporate targets and goals. Based upon strategic initiatives and departmental goals assist in the development of daily work plan to achieve desired goal Oversees operational activities of the OP Case staff. Provide direct support and resources to OP Case Management to effectively improve management of the patient population, excess utilization, ER visits, hospitalization and readmission. Work collaboratively with other members of the population Health Management Team to achieve desired outcomes. Participates on committees and conducts studies as necessary to demonstrate improvement in case management processes. * Proficient in negotiating complex systems to effect positive change. * Must possess skills required to run a fiscally responsible program while ensuring constant improvement * Actively involved in process redesign to eliminate overutilization, manage complex cases and decrease over all expense to deliver care. Monitor and evaluate OP Case Management staffing productivity and effectiveness * Manages OP CM staff to decrease number of ER/IP visit, medication management, disease specific health coaching, behavioral modification, improve transitions of care. * Ensure proper onboarding and education/orientation, data tracking and analysis, documentation and compliance with program initiatives. * Proficient in communicating clearly and effectively with multiple constituents * Proficient on computer usage, esp. database and spreadsheet analysis Accountable for meeting and managing departmental goals and budget. * Review monthly department budget reports and design action plan to address budget variances Review the Department program to ensure compliance to state and regulatory guidelines. * Broad knowledge of insurance regulations and Medicare and Medicaid guidelines Identify staff development opportunities and evaluation tasks for OP Care Coordination staff. * Ownership of Outpatient Case Management staff annual employee engagement with active action plan to address issues. Performs other duties as assigned Complies with all WellStar Health System policies, standards of work, and code of conduct.

Required Minimum Education:

Graduate of an accredited/approved school of nursing current licensure as a registered professional nurse in the State of Georgia Bachelor's Degree in Social Work Baccalaureate degree in nursing (BSN) Master's Degree in Social Work (MSW) Master's Degree in nursing (MSN)

Required Minimum License(s) and Certification(s):

All certifications are required upon hire unless otherwise stated.

• Lic Master Social Worker GA or Reg Nurse (Single State) or RN - Multi-state Compact
• Basic Life Support or BLS - Instructor

Additional License(s) and Certification(s):

Required Minimum Experience:

Minimum 5 years recent case management experience in acute inpatient Required and Minimum 5 years acute care experience as a registered nurse or social worker required Required and Previous management experience Preferred

Required Minimum Skills:

strong experience with Microsoft office suite and working with excel spreadsheets Skill in identifying problems and recommending solutions Skill in preparing and maintaining records and written reports Skill in establishing and maintaining effective working relationships with physicians and office staff, hospital staff, community partners and vendors Ability to interpret, adapts, and applies guidelines and procedures Ability to analyze complex clinical scenarios and apply critical thinking Extensive knowledge of managing patient populations, transitions in care and community resources

Join us and discover the support to do more meaningful work—and enjoy a more rewarding life. Connect with the most integrated health system in Georgia, and start a future that gives you more.

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