Manager, Care Management Services (Fortify)

GENERAL SUMMARY The Manager, Care Management Services is responsible for leading a robust care management program across the clinically integrated network, Fortify Children’s Health.
This program aims to enhance the health and well-being of attributed patients, improve service provider outreach and adoption, and ensure the program's effective execution.
The Fortify Cares care management program supports Fortify’s overall vision and mission by working towards the optimal well-being of the children inclusive of their medical and social needs while serving as a leader in pediatric population health.
The Manager, Care Management Services strategically collaborates with key members of the Fortify Executive Team, including the Medical Director, Director of Clinical Operations, Regional Medical Directors, Executive Director, and Director of Strategic Transformation to execute and optimize a comprehensive care management program across the clinically integrated network.
Reports to the Medical Director of Fortify or management designee.
ESSENTIAL DUTIES AND RESPONSIBILITIES Works closely with care management team supervisors and Medical Director to establish a cohesive and efficient team dedicated to the well-being of children and families.
Engages in collaboration with leaders of other care management, case management, and disease management programs at UVA, CHKD and other network partners to ensure a seamlessly integrated process for families, staff and providers seeking access to care management services.
Provides network-wide oversight for care management responsibilities including key performance indicators (KPI) and chart audit processes of all care management team members, encompassing screening, outreach, assessment, interventions, gap identification, and connection with community-based resources.
Monitors and reviews hybrid and centralized care management KPIs weekly with supervisors.
Provides an assessment and outcome goals to leadership to improve and/or maintain performance.
Collaborates with leadership to review care management KPI data and execute quality improvement opportunities.
Monitors and supports quality improvement efforts tied to the care management program Performs monthly chart audit assessments of all care management team members to review training and quality improvement opportunities related to the chart audit process.
Provides educational and training opportunities by creating and executing a care coordination curriculum to train all care management and care coordination staff of participating entities.
Presents Care Coordination Training curriculum with case studies to leadership no less than once a month.
Creates and utilizes post training assessments to ensure competencies are fully integrated into established care management workflows.
(i.
e.
AMR education) Facilitates the development of standardized documentation processes and monitors for optimal performance in service delivery.
Establishes, supports, and monitors weekly telehealth utilization goals while upholding the established telehealth utilization technologies standards.
Every 6 months, articulates, creates and distributes communications and standardized reporting relevant telehealth utilization reporting to leadership.
Implements and evaluates new and existing care management service opportunities, prioritizing at-risk populations to enhance patient outcomes.
Supports care managers through the patient satisfaction survey process upon transition, monitoring success and integrating evaluation into CM program enhancements sharing outcomes with leadership.
Influences staff, physicians, and leadership by sharing knowledge regarding the value and appropriate use of this program.
Establishes and nurtures relationships to build networks within parent organizations, network provider groups, and the community to identify crucial resources and information for care managers working to deliver the highest quality care for attributed patients.
Assesses and develops recommendations for new or revised care management policies, procedures, and guidelines.
Works in partnership with researchers and other program support staff to demonstrate value while streamlining the care experience.
Provides multi-disciplinary case consultation as needed.
Supervises assigned staff to include interviewing, selecting, training, motivating, evaluating, counseling, disciplining and terminating in compliance with EEO/AA goals and personnel policies of the organization.
Supports and develops supervisory staff.
Ensures completion of employee performance reviews for every member of the team according to Fortify policy.
Shares a formal assessment of strengths and opportunities for individuals and the program with leadership.
Ensures compliance with contractual, regulatory, and accreditation requirements.
Performs other duties as assigned.
LICENSES AND/OR CERTIFICATIONS Current Virginia state license as a Registered Nurse or Registered Nurse holding a valid Compact State license or as a License Clinical Social Worker (LSCW) required.
Certified Care Manager strongly preferred.
MINIMUM EDUCATION AND EXPERIENCE REQUIREMENTS Bachelor's degree in nursing, social work, business, healthcare or a related field required.
Master's degree in nursing, public health or healthcare administration preferred.
5+ years of system - or network - level care management program experience in diversified healthcare system, health insurance company, or a related field required.
3+ years of experience in a clinical environment (e.
g.
, faculty practice plan, clinical department of an academic medical center, medical group practice, or clinical operations department of a managed care organization) supporting physicians, process improvement and operational initiatives required.
2+ years of care management supervisory experience required.
Knowledgeable of continuous improvement methodologies and process flow management, specifically focused on determining the most efficient and effective processes to accomplish desired results.
Ability to work with data and reporting tools to research, organize, and summarize findings.
Strong proficiency and technical aptitude in Epic, Cerner or similar EMR; or managed care software applications and MS Office products, including Excel, PowerPoint, Outlook and Word.
High technical and functional aptitude for problem solving and critical thinking.
Ability to maneuver comfortably through complex policy, process and people-related organizational dynamics while building relationships with diverse individuals.
Ability to apply knowledge of business and healthcare marketplace to advance the organization’s goals.
Ability to lead cross-functional teams.
Strong organizational skills with strong attention to detail and a commitment to accuracy.
Must possess strong verbal, written, and interpersonal skills.
Must be self-directed, self-motivated and have a high level of personal initiative.
Excellent time management skills with the ability to prioritize multiple and competing tasks, ability to shift priorities and able to work independently in a fast paced, fluid environment.
WORKING CONDITIONS Normal office environment with little exposure to excessive noise, dust, temperature and the like.
PHYSICAL REQUIREMENTS Click here to view physical requirements.
#CHKDHP Location: Childrens Hospital of The Kings Daughters · Fortify Childrens Health Schedule: Full-Time, Days, 8-5/M-F