The Care Management Program Leader will be responsible for implementation and management of a high-volume, multi-state Chronic Care Management program. The leader will manage the delivery of Chronic Care Management services to include patient-centered assessment, planning, intervention, and evaluation through the development of processes and tools that promote communication and exchange of information between care settings. The leader will direct and oversee the key functions of a team that works with patients, CRC providers, and other care team members to provide Chronic Care Management services allowing patients to thrive and progress toward desired outcomes.
Provide care management and coordination services through the management of a team of care manager/coordination staff, including clinicians and non-clinical staff
Identifies and participates in the development of ongoing orientation, educational, and training programs for the Chronic Care Management department
Hire, train, develop, and manage staff to ensure that a qualified staff exists to meet program objectives.
Plan, assign, direct, and review work of staff
Determine personnel, material, and resources needed to accomplish program goals
Provide clinical leadership for the Chronic Care Management program by serving as an educator, role model, advocate, and change agent to enhance patient care and staff competency
Develops, implements and monitors standardized protocols for team activities to facilitate integrated, proactive care management
Plan, select, and monitor care management operations, work methods, procedures, workflow and standards for quality and quantity of work, including staffing standards
Oversight and evaluation of clinical processes to ensure continuous review and improvement of process workflow
Monitors and assess external environment and internal trends and practices. Adopts and implements industry evidence-based best practices where applicable
Regulatory and Compliance:
Administer and maintain care management documentation system and standard workflows to ensure exceptional patient care, maximum productivity, and compliance with regulatory and compliance requirements
Be the point of contact with delegate and clinical vendor relationships.
Proactively monitor all Federal, state, and local regulatory requirements and ensure all care management related requirements are met
Establish processes for ongoing monitoring and evaluation of operations for compliance with licensure, accreditation, and regulatory standards.
Work with the Revenue Cycle department to ensure denial prevention activities are in place and to understand the causes of denials in order to assist with denials management.
Performance and Quality Improvement:
Responsible for all departmental performance metrics, cost effectiveness, ongoing quality, productivity and overall efficiency for the Chronic Care Management program
Establish strong operational metrics and auditing to ensure quality
Analyze data and identify trends monthly to ensure program goals meet or exceed industry benchmarks, regulatory requirements, and service level agreements
Collaborate with the leadership and providers to ensure barriers to care management performance metrics are addressed timely with focus on identifying and driving performance improvement initiatives
Keeps leadership informed of operational issues, staffing, resources, system and program needs and presents solution action plans for issues
Education and Experience:
Must be a Registered Nurse (RN) with an active US license
A minimum of five (5) years of care management or managed healthcare experience with at least one (1) year of line management responsibility including clinical operations required
A minimum of two (2) years of experience developing programs/processes to support care management or coordination required
CMC Certification preferred
Experience working in primary care or chronic condition care management required
Experience administering care management for Medicare beneficiary population preferred
Proficiency in applicable Federal, state, and third-party care management regulations required
Operational and process improvement experience preferred
Competencies, Knowledge and Skills:
Proven leadership in successfully implementing new strategies, change management, team building, motivating staff with enthusiasm and compassion, communicating skills across disciplines.
Strong ability to teach best practice and engagement strategies for successful member participation (including motivational interviewing, best practice engagement techniques)
Knowledge and experience with electronic medical record (EMR) and Care Management technology, coding/billing, and Revenue Cycle management
Understanding of current Medicare compliance requirements.
Willingness to perform Care Manager duties as needed
Display a customer service, patient-focused orientation
Strong collaboration and conflict resolution skill sets
Strong project management skills
Strong decision making and problem-solving skills
Strong process and analytical skills with the ability to articulate and define outcome measures that capture key performance metrics
Exceptional communication skills (both written and verbal) with the ability to present information in a variety of different formats to all levels
Ability to develop, prioritize and accomplish goals/time management
Comprehensive Rehab Consultants
Oakbrook (remote position)
Chicago, IL, IL 60611