RN Manager, Clinical Operations - Care Transformation

General Summary of Position
Leads the daily operations of the interdisciplinary care management team capable of furnishing an array of care coordination services to Medicare FFS beneficiaries attributed to practices that the Care Transformation Organization (CTO) supports. Responsible for the implementation, integration, and overall operational direction of the CTO interdisciplinary care team through organizing, directing, assessing, and evaluating a clinical system that manages cost and quality patient care outcomes.
EDUCATION: Bachelor's degree in Nursing; Master's degree in nursing preferred.
EXPERIENCE: 2 years case management experience; 4 years diverse clinical experience in a hospital or
medical setting; 2 years supervisory experience.
LICENSE/CERT/REG: Valid RN license in Maryland. CCM (Certified Case Manager) required.
SKILLS: Effective verbal and written communication skills. Excellent interpersonal and customer service skills especially serving geriatric patients. Strong analytical and critical thinking skills. Strong community engagement and facilitation skills. Advanced project management skills. Commitment to collective impact concepts. Flexibility and the ability to work autonomously as well as take direction as needed. Cultural competency. Proficient computer skills along with experience using Microsoft applications-Word, Excel, etc. and familiarity with entering data in an electronic medical record (EMR).
Primary Duties and Responsibilities
  • Provides daily supervision and oversight of an interdisciplinary care team that includes a diverse team of health professionals including lead case managers, Case Managers, care coordinators, social workers, pharmacy technicians, dieticians, health educators and other health professionals.
  • Supervises the interdisciplinary care team to ensure the following MD Primary Care program care coordination goals are met:
  • Attributed beneficiaries have timely access to care (same day or next day access to the patient's own practitioner and/or care team for urgent care or transition management)
  • Facilitate use of alternatives for care outside of the traditional office visit to increase access to the care team and the practitioner, such as e-visits, phone visits, group visits, home visits, and visits in alternate locations (senior centers, assisted living) captured in the medical record
  • Assist patients with scheduling appointments with providers including annual wellness visits. Attributed beneficiaries receive a follow up interaction from the practice within 2 days for hospital discharge and within one week for Emergency Department (ED) discharges.
  • Coordinates referral management for attributed beneficiaries seeking care from high-volume and/or high-cost specialists as well as EDs and hospital.
  • Facilitate connection to services for patients who may benefit from behavioral health services, including: patients with serious mental illness; patients with substance use disorders' patients with depression, anxiety, or other mental health conditions; patients with behavioral and social risk factors and BH issues; patients with multiple co-morbidities and BH issues
  • Assist with identifying patients to participate in the Patient-Family/ Caregiver Advisory Council (PFAC) and help to organize and facilitate the PFAC annual meetings
  • Engage attributed beneficiaries and caregivers in a collaborative process for advance care planning (MOLST, Advanced Directives, Proxy)
  • Acts as the System Administrator for the care management software system. Able to update tables, identify issues with the software, coordinate training, and coordinate testing for system upgrades. Acts as a resource to staff and outside vendors using the software.
  • Develops department goals, objectives, policies, procedures, performance and productivity standards.
  • Ensures compliance with policies and procedures and governmental regulations.
  • Responsible for the development of policies and procedures for the department. Updates policies at least annually.
  • Oversees training program for new staff and is responsible for maintaining an up to date training manual for each area of the department.
  • Participates in multidisciplinary quality service improvement teams. Participates in meetings and committees and represents the department and in community outreach efforts.
  • Provides ongoing individual coaching and support to staff and acts as a resource for clinical, social, utilization and appeal review issues as they relate to case management. Meets regularly with department members to enhance communication and facilitate implementation and progress towards program objectives. Assists staff members to set personal and educational goals and objectives to enhance their professional development.
  • Responsible to coordinate and conduct studies for the various quality measures required by State regulatory guidelines and NCQA. Evaluates member satisfaction with CM and DM, makes modifications as necessary to improve satisfaction.
  • Selects, trains, orients and assigns department staff. Develops standards of performance, evaluates performance, and conducts performance management planning. Initiates or makes recommendations for personnel actions. Maintains ongoing communication with subordinates to review programs, provide feedback, discuss new developments and exchange information.
  • Serve as the Case Management point of contact and expert.
  • Works collaboratively with the Data Analyst to develop reports to meet the departments objectives. Uses technology to enhance decision making and effectiveness.
About MedStar Health
MedStar Health is dedicated to providing the highest quality care for people in Maryland and the Washington, D.C., region, while advancing the practice of medicine through education, innovation and research. Our 30,000 associates and 5,400 affiliated physicians work in a variety of settings across our health system, including 10 hospitals and more than 300 community-based locations, the largest visiting nurse association in the region, and highly respected institutes dedicated to research and innovation. As the medical education and clinical partner of Georgetown University for more than 20 years, MedStar is dedicated not only to teaching the next generation of doctors, but also to the continuing education and professional development of our whole team. MedStar Health offers diverse opportunities for career advancement and personal fulfillment.

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