Clinical Manager; Boston area

Job Summary

Under the general direction of the Senior Manager or Director, Integrated Care Management
- Nursing, the Manager, Integrated Care Management
- Nursing, is responsible for day-to-day operations and staff within his/her jurisdiction. The Manager is responsible for implementation, monitoring and oversight of care management functions and programs, including assurance of quality evidence-based care management practice, adherence to regulatory and accreditation standards; and to delivery of defined metrics to validate business unit/program effectiveness. The Manager, Integrated Care Management
-Nursing works collaboratively within Clinical Services and other Point
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Health partner departments to identify and address opportunities to improve service, reduce administrative cost and support department, Line of Business (LOB) division, and organizational business goals. The Manager, Integrated Care Management
- Nursing is also accountable for recruitment, evaluation, management, and ongoing development, of care management department staff, working in a remote and/or office environment. With his/her Care Management program, support members with chronic condition and complex medical needs including adult, geriatric, and pediatric and high-risk pregnancy. Members are identified as they transition to home following acute care or extended care admissions or emergency room use;

in addition, members are referred by providers, self-referral, care givers and predictive modeling.

• Business Process Implementation and Oversight:
  • Responsible for implementation and monitoring effectiveness of new and existing Care Management programs, including but not limited to:
  • Telephonic care management and onsite transition of care interventions
  • Compliance with applicable regulatory and accrediting standards; care management process and interventions consistent with national best practices; demonstrated through scheduled department and quality audits
  • Defining and monitoring outcomes and regular reporting for areas of accountability
  • Interface with Care Management vendors and programs for bidirectional referrals
  • Establishment of written policies and procedures pertaining to Care Management.
• Staff Development
  • Provide direct oversight of coordinators, RN care managers and other interdisciplinary staff working in a remote and/or office-based or hybrid environment. May supervise staff performing member home visits.
  • Guide and enhance the core competencies and professional development of reporting staff
  • Facilitate and enhance team collaboration to optimize program and member outcomes through integrated services,
  • Facilitate collaboration with internal and external stakeholders to maximize partnerships for case management program success, including alignment with provider network and employers
  • Serve as consultant and resource for complex situations.
• Resource Management
  • Oversee the management of department human resources related objectives
  • Support realization of department administrative budget targets
• Corporate Participation
  • Represent Care Management in relevant corporate teams as required
  • Implement and support fulfillment of corporate objectives within jurisdiction
• Other projects and duties as assigned.

• Registered Nurse with current unrestricted Massachusetts license required
• National Certification in Case Management is preferred

• Required (minimum):
  
  Bachelor’s degree or equivalent relevant experience
• Preferred: BA/BS Degree

• Required (minimum): 5 years of RN experience in nursing in a clinical setting.
• Preferred:
  Experience in managed care systems and operations is highly desirable and must demonstrate sound knowledge of care management principles. 2-3 years of experience managing and leading a team. Expertise in oversight of business process change and leading people is. Prior home care experience.

• Excellent communication skills (verbal, electronic, etc.)
• Must possess skills and traits of an effective Coach, Mentor, and Critical Thinker.
• Demonstrates ability to manage and…