Manager, Care Coordination, 40 Hour Days

UMass Memorial Health; Worcester (MA); Presencial; USD 114.000 - 206.000; Jornada completa

Descripción de la vacante

UMass Memorial Health in Worcester, MA is seeking a Nurse Manager to direct the Care Coordination Department, ensuring performance, regulatory compliance, and efficient patient flow. This exempt, full-time leadership role requires a BSN and experience in case management or hospital leadership.

The position oversees staff, develops plans for growth, maintains scheduling, and collaborates with physicians and administrative leadership to meet regulatory requirements and improve care quality.

Formación

• Licensed RN with BSN required.
• Master's degree or ACM-RN/ CCM preferred.
• One year acute hospital experience as direct care clinician or case manager.
• Experience leading staff or large-scale project implementation.
• Knowledge of DRGs, Medicare regulations, medical necessity criteria, HIPAA, and the Patient Bill of Rights.

Responsabilidades

• Directs and supervises assigned personnel, including scheduling, orientation, and training.
• Develops budgets and ensures financial goals are met.
• Coordinates task assignments and resolves operational problems.
• Leads staff and aligns efforts with system-wide initiatives and diversity objectives.
• Ensures compliance with Joint Commission, DPH and safety requirements.
• Maintains attendance, and develops plans for growth and change within the department.
• Engages with physicians, executives and department heads to improve care and policy alignment.

Conocimientos

Computer skills

Critical thinking

DRGs knowledge

Medicare regulations

Medical necessity criteria

HIPAA

Patient bill of rights

Educación

BSN

Master's degree or higher

ACM-RN

CCM

Descripción del empleo

Exemption Status: Exempt

Hiring Range: $114,441.60 - $206,003.20

(based on a full time schedule of 40 hours per week).

Please note that the final offer will vary based on scheduled hours. Compensation for part-time or reduced schedules will be prorated based on scheduled weekly hours, experience, skills, qualifications, and internal equity considerations.

Schedule Details: Monday through Friday

Scheduled Hours: 0630 - 1630

Shift: 1 - Day Shift, 8 Hours (United States of America)

Hours: 40

Cost Center: 10030 - 6214 Care Coordination Dept

This position may have a signing bonus available a member of the Recruitment Team will confirm eligibility during the interview process.

Everyone Is a Caregiver

At UMass Memorial Health, everyone is a caregiver - regardless of their title or responsibilities. Exceptional patient care, academic excellence and leading-edge research make UMass Memorial the premier health system of Central Massachusetts, and a place where we can help you build the career you deserve. We are more than 20,000 employees, working together as one health system in a relentless pursuit of healing for our patients, community and each other. And everyone, in their own unique way, plays an important part, every day.

The Nurse Manager is responsible and accountable for organizing, directing, and coordination of clinical and administrative performance of the Care Coordination Department. Facilitates collaboration with medical and administrative leadership to assure the Conditions of Participation and patient discharge needs are met. Facilitates compliance with Utilization Review and level of care standards. The scope of responsibilities includes clinical and safety practices of nurses, professional nursing practice, leadership and professional growth, human resource management, financial performance, system coordination and clinical performance (safety, satisfaction, and quality) improvement.

I. Major Responsibilities:

• 1. Conducts Long Stay/Complex Care Rounds with the Physician Advisor and follows-up with key Next Steps within 24 hours of Rounds.
• 2. Participates in Complex Rounds for patient with Long length of stay and follows up with key next steps as indicated.
• 3. Develops effective relationships with the Physician Advisor (s) and other leadership physicians for effective relationships with physicians, services, specialties, etc.
• 4. Provides consultation to the executive team, forming effective relationships with The Director, VPs, and department heads, keeping them up to date about regulatory issues, health care and policy reform, payer behaviors, etc. as requested by the Director
• 5. Participates in the determination, definition, and periodic evaluation of a Case Management Dashboard, using data to better understand strengths and weaknesses of the hospital and department, and to determine needs, decisions, and strategies.
• 6. Provides effective communication systems and forums with third party payers, the local PRO/QIO, Medical Records, and the Managed Care and finance offices.
• 7. Helps creates and manage interventions for unforeseen regional, community, and internal hospital crises.
• 8. Manages all software and sets up training as necessary.
• 9. Creates a yearly, weekly, and daily schedule in compliance with MNA contract and keeps personnel aware of changes, needs, and adjustments in staffing or scheduling required to meet the immediate and long-term goals of the department.
• 10. With the Director, develops a formal plan for growth and/or change for employees, as needed.
• 11. Conducts staff meetings and gives assistance to special internal department committees and projects.
• 12. Manages stable and reliable processes to anticipate and address specific situations within the department and between the department and other departments and external agencies.
• 13. Joins networks of case management professionals and attends conferences that are targeted at own identified learning needs as well as the interests of the health system.

Standard Management Level Responsibilities:

• 1. Directs and supervises assigned personnel including performance evaluations, scheduling, orientation, and training. Makes recommendations on employee hires, transfers, promotions, salary changes, discipline, terminations, and similar actions. Resolves grievances and other personnel problems within position responsibilities.
• 2. Develops and recommends the budgets for the areas managed. Manages activities to assure financial goals are met.
• 3. Coordinates the assignment of tasks and helps resolve technical and operational problems. Evaluates the impact of solutions to ensure goals are achieved.
• 4. Provides effective direction, guidance, and leadership over the staff for effective teamwork and motivation and fosters the effective integration of efforts with system-wide initiatives.
• 5. Encourages and supports diverse views and approaches, demonstrates Standards of Respect, and contributes to creating and maintaining an environment of professionalism, respect, tolerance, civility and acceptance toward all employees, patients and visitors.
• 6. Integrates diversity into departmental objectives, such as hiring, promotions, training, vendor selections, etc.
• 7. Participates in performance improvement initiatives and demonstrates the use of quality improvement in daily operations.
• 8. Ensures compliance with regulatory agencies such as Joint Commission, DPH, etc. Develops and maintains procedures necessary to meet regulatory requirements.
• 9. Ensures that department complies with hospital established policies, quality assurance programs, safety, and infection control policies and procedures.
• 10. Ensures adequate equipment and supplies for department.
• 11. Develops and maintains established departmental policies, procedures, and objectives.
• 12. Ensures compliance to all health and safety regulations and requirements.
• 13. Maintains, regular, reliable, and predictable attendance.
• 14. Performs similar or related duties as required or directed.

All responsibilities are essential job functions.

II. Position Qualifications:

License/Certification/Education:

• Required:
  1. Licensed Registered Nurse with BSN or equivalent.

Preferred:

• 1. Master's Degree or equivalent.
• 2. ACM -RN or CCM
• 3. CMAC (Certification as a Case Management Administrator).

Experience/Skill:

Required:

• 1. One-year acute hospital experience as a direct care clinician or case manager, and One-year experience in non-hospital-based health care (home care, insurance, outpatient, etc).
• 2. Previous experience managing staff or leading a successful large-scale project implementation. Demonstrated leadership potential.
• 3. Must have computer skills, critical thinking skills, knowledge of DRGs, Medicare Regulations, Medical Necessity Criteria, Patient Bill of Rights, and HIPAA.
• 4. Knowledge and skills in the following areas are a necessity: Human Resource management, program evaluation using subjective and objective data, market assessment and strategic planning, leadership for change/change management/operational improvement, assessment and implementation of clinical systems, identification of at-risk populations, development of strategies to manage at-risk populations, use of clinical software, collaborative, energetic, proactive, and technical writing for reports, letters, proposals, etc.

Preferred:

• 1. Master's Degree or equivalent.
• 2. ACM -RN or CCM
• 3. CMAC (Certification as a Case Management Administrator).

Unless certification, licensure or registration is required, an equivalent combination of education and experience may be substituted for the above requirements.

Department-specific competencies, including age-specific competencies and their measurements, will be developed and maintained in the individual departments. The competencies will be maintained and attached to the departmental job description. Responsible managers will review competencies with position incumbents.

III. Physical Demands and Environmental Conditions:

Work is considered sedentary. Position required work indoors in a normal office and patient care environment.

Also to cover Marlborough campus

on call for telephonic urgent issues on weekends (rotating)

All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability or protected veteran status.

We're striving to make respect a part of everything we do at UMass Memorial Health - for our patients, our community and each other. Our six Standards of Respect are: Acknowledge, Listen, Communicate, Be Responsive, Be a Team Player and Be Kind. If you share these Standards of Respect, we hope you will join our team and help us make respect our standard for everyone, every day.

As an equal opportunity and affirmative action employer, UMass Memorial Health recognizes the power of a diverse community and encourages applications from individuals with varied experiences, perspectives and backgrounds. All qualified applicants will receive consideration for employment without regard to race, color, religion, gender, sexual orientation, national origin, age, disability, gender identity and expression, protected veteran status or other status protected by law.

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