Registered Nurse Care Manager, Transitional - Strive Health

RN Care Manager, Transitional

The TCM oversees the day-to-day operations of the Complex Case Management program under the direction of the Senior Director of Care Management. The TCM is accountable for the following Case Management functions: training, auditing, systems support: Case Management Technology, and reporting. Leads efforts to develop, implement, evaluate, redesign, and modify Complex Case Management practice standards. Works closely with the CM leads and staff in an effort to safely, effectively and efficiently assist patients across and through the continuum of Case.

Essential Functions

• Develops reporting tools to assist CM Director and executive leadership teams to assess the effectiveness of CM efforts.
• Collaborates with other Strive departments to establish mechanisms to address issues related to Case management, tracking, trending, and documentation. 
• Reports trends/barriers to CM Director
• Collaborates with other staff to develop performance improvement activities as indicated.
• Oversees daily operations of the Intensive Case Manager (ICM) leads and staff under the direction of the Director of Care Management.
• Conducts employee performance reviews.
• Utilizes identified trends to develop training tools to facilitate achievement of KPIs
• Monitors and mentors Case Management staff.
• Collaborates with other departments to generate outcome data as needed to measure and trend performance indicators.
• Coordinates with CM staff to ensure safe/effective/efficient plans of Care are implemented
• Conducts chart audits per established policy to ensure achievement of NCQA accreditation
• Ensures training programs address identified needs of ICM staff
• Assists with forecasting of staffing requirements
• Collaborates with CM Director, Quality Director, Clinical Delivery, Market Leadership, and staff to ensure effective processes and systems are established and maintained to meet goals.
• Participates in leadership development.
• Functions as a resource person for the Complex Case Management processes pertaining to NCQA and CCM efforts.
• Coordinates daily flow of the ICM team (this includes overseeing PTO requests, assignment coverage, on-call coverage)
• Takes a leadership role in the mentoring and monitoring of documentation expectations in Case Management technology.
• Analyzes data for trends and causative factors that promote or impede progression toward positive Case management outcomes.

Minimum Qualifications

• 3 year supervisory/management experience
• 3 years experience with NCQA CCM accreditation
• Graduate of an accredited school of nursing
• Bachelor's degree in Nursing or related field
• 4  years nursing experience.
• 4 years complex Case management experience or equivalent experience in health care environment
• Current Registered Nursing Licensure
• Case Management certification or agreement to renew/obtain upon 3 months of hire required
• Internet Connectivity - Min Speeds: 3.8Mbps/3.0Mbps (up/down): Latency <60 ms

Preferred Qualifications

• Managed/Value-Based Case and payor experience preferred.
• Ability to build credible and effective relationships across a matrixed environment.
• Strong analytical skills.
• Strong project management skills.
• Excellent communication and interpersonal skills.
• Demonstrated leadership capabilities.
• Current knowledge of CKD/ESRD and Complex CM processes preferred.
• Use of expert clinical practice, leadership skills, and critical thinking skills to efficiently coordinate and direct patient care are among all health care providers, while maximizing use of resources is required.
• The ability to prepare and critically analyze data, make appropriate recommendations toward resolution, and follow-through of identified action is required.
• Expertise in interpersonal relationships, organizational relations, and effective communication, negotiation, and conflict resolution skills are required.
• The motivation and drive to work independently with minimal supervision to pursue continuous development of self and others are required.
• Strong sense of commitment and of being in control of one's practice is needed. Ability to effectively resolve practice issues and facilitate practice changes within the organization and throughout the continuum of care is required.
• Ability to foster principles of participative management by identifying/involving relevant individuals in program-related decisions is required.
• Ability to apply creative and innovative approaches to develop and maintain systems that achieve higher levels of multi-disciplinary team performance and desired patient outcomes is needed.