If you are interested please apply online and send resumes to NOrozco@mlkch.org
The Care Management Supervisor is a leadership position that requires experience in care management, excellent clinical skills, and leadership qualities. Reporting to the Manager of Care Management, the Supervisor of Care Management has hospital-wide accountability for overseeing care management and utilization review processes which include: (1) inpatient admission with continued and extended hospital stays, (2) discharge reviews (3) inpatient medical necessity, (4) assurance of high quality care, (5) efficient use of available care management resources, and (6) Health Plan reimbursement categorical knowledge. The role requires maintaining appropriate and up-to-date knowledge of RN scope of practice, current state requirements, CMS Conditions of Participation, EMTALA, The Patient Bill of Rights, AB1203, and other Federal or State regulatory agency requirements specific to Care Management, Utilization Review, and Discharge Planning. The Supervisor of Care Management partners with the medical staff and senior and mid-level Care Management leadership in making decisions of how to resolve patient conflicts and advance acute care processes. The Supervisor of Care Management utilizes scientific evidence for creating and implementing best practices, and relevant data to manage patient care and function as a support liaison for the Care Management team. This position requires the full understanding and active participation in fulfilling the Mission of Martin Luther King, Jr. Community Hospital. It is expected that the employee will demonstrate behavior consistent with the Core Values. The employee shall support Martin Luther King, Jr. Community Hospital's strategic plan and the goals and direction of the quality and performance improvement process activities. The Watson Model of Care is utilized throughout the delivery of care system.
ESSENTIAL DUTIES AND RESPONSIBILITIES
- Manages MLK's Homeless Policy and integrally involved in the discharge process
- Functions as a Super User training for the Care Collaborative System.
- Conducts ongoing education of staff on how to prepare thorough documentation in the medical record
- Participates in integrated testing for the Care Collaborative System and Cerner upgrades.
- Coordinates the new employees for system training.
- Makes sure that ESARFS are completed in a thorough and timely manner.
- Responsible to coordinate the preceptor training schedule in collaboration with the CM Educator and Manager.
- Participates in mapping and overseeing space allocations for team members.
- Coordinates unit orientation of new employees.
- Creates well-articulated workflows, clinical pathways, and teaching tools for education.
- Any other duties to assure the unit is ready each day..
Role Specific Duties and Responsibilities
- Functions as a nurse model in mitigating conflict, and resolving care dilemmas utilizing conflict resolution skills.
- Monitors and supports the interdisciplinary team process to facilitate timely care, assure quality of care to patients throughout the hospital stay, and minimize adverse outcomes.
- Oversees the patient referral process and ensures appropriateness to outside provider networks (Health Plans, IPA's, FQHC's, SNFs, Board and Cares, Recuperative Care, Sub-acute cares, and PCP/Specialty offices).
- Resolves conflicts relating to admitting services with Patient Access and makes decisions in that regard by considering the needs of the patient, payer, and provider.
- Enhances team knowledge by providing front line education regarding UM, CM, and effective discharge planning.
- Communicates relevant elements of the health plan structure to CM team, as determines is necessary.
- Conducts chart audits as necessary to reinforce documentation and compliance requirements of CM department.
- Participates in multi-disciplinary and departmental meetings as assigned by the Manager.
- Provides front line education in reaffirming CM processes in collaboration with the CM Educator and/or SW Educator.
- Ensures that staff and others adhere to the Care Management Department policies and procedures.
- Oversees implementation and maintenance of the Quality and Performance Improvement Plan for the Care Management Department.
- Ensures departmental reformation and project implementation to enhance performance.
- Considers the patient population served, age-specific criteria, the Watson Model of Care, and other pertinent factors, as appropriate, when engaging in all patient/family care and interaction.
- Understands and implements Milliman Care Guidelines relating to best practices to determine patient disposition.
- Collaborates and works closely with onsite Hospitalists, Intensivists, Emergency Physicians, and other members of the Medical Staff. Physicians when needed.
- Prepares the Complex Cases for the SNF & HH weekly meetings & presents potential patients
- Attends daily discharge huddle meetings with nursing to present discharge list.
- Manages patient care gap when determines staffing is deficient, as necessary.
- Participates in unit/department staff meetings as well as other meetings as appropriate.
- Other duties to accomplish goals as necessary including working as an RN CM if needed to ensure patient discharges.
- Works with ED & Inpatient CM to ensure that MCG reviews are completed daily.
- BSN is required. Candidates with ASN and at least six (6) years of Care Management experience will be considered in lieu of BSN.
- Minimum of one (1) to three (3) years of hospital inpatient supervisory or related experience required and at least two (2) years of hospital inpatient care management experience.
- Able to navigate and connect successfully with outside provider networks (Health Plans, IPA's, and FQHC's).
- Internal candidates will be considered at management's discretion.
- Current California Nursing license
- Certification in Case Management (CMC or ACM) preferred but must be obtained within 1 year after hire.
C. Special Skills/Knowledge
- Bilingual language skills preferred (Spanish)
- Basic computer skills
- Current Basic Life Support (BLS)
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