Job Description

Location: St. Joseph Medical Center
Posted Date: 5/12/2021

Job Description: The Lead Care Manager is responsible for assisting with all the daily operations of the Care Management Department. The Lead assists the Department Director in employee supervision, management, and training; data research and analysis; development and implementation of quality initiatives designed to support defined objectives. Guides team in resource management. Maintains the standard for a collaborative process of assessment, planning, facilitation, and advocacy for patients in our care. Individualizes services to meets patient's health care needs by utilizing available resources to promote quality outcomes. The Lead Care Manager will act in the role of a staff Care Manager when needed.

Skill Set: Ability to work competently with computer-based charting and other clinical and non-clinical software programs. Adaptability to change and good organizational skills required. Ability to read and communicate effectively in English. Can be expected to do presentations as directed. Working knowledge of criteria for Medicare, Medicaid, HMO, and private insurance carrier’s coverage details. Ability to advocate for patients. Ability to operate office equipment. Possess critical thinking skills. Leadership skills required for role include effective mentoring, coaching, counseling, time management, problem solving, and strategic planning. Demonstrates initiative and pro-active approach to problem resolution. Ability to effectively interact with insurance companies and community healthcare recourses. Ability to work in a stressful, fast paced environment. Must master Microsoft Office Products, i.e. Excel, Word etc. Understand CMI, patient status, InterQual Criteria, Milliman Criteria, and Transfer DRGs.

Assists Director with the daily operations of the Care Management Department.

Assists with scheduling staff in compliance with productivity measurements.

Participates with department audits.

Assists with staff selection, orientation, training, coaching, counseling, and assessment of performance.

Makes appropriate referrals to Transitional Care services for patients frequently readmitted. Collaborates with Transitional Care leadership to review data trends/outcomes.

RN: Actively prevents medical necessity denials by submitting referrals to physician advisor for status review. Documents in CM system. Discusses recommendations with physicians. Ensures updated documentation occurs post discussion.

RN: Screens all transfers to/from other facilities for appropriate placement and level of care. Further ensures transfers from the ED follow EMTALA. Assists in providing appropriate Memorandum of Transfer for all patients transferring to another facility are completed. Documents in CM system.

Initiates referrals to Ethics Committee, Risk Management, or legal services, as appropriate.

Refers potential quality issues to Care Management leadership, Risk Management, Pharmacy, or Infection Control. Attends committee meetings as directed.

Assists with monthly reporting preparation.

Attends scheduled meetings and performs presentations as needed/designated.

Serves as a resource to staff seeking assistance, guidance, and information from the Care Management Department.

Builds relationships with internal and external customers including Care Management staff, patients, medical staff, hospital staff, and other key stakeholders.

Monitors new developments in regulations, policies, and trends, that impact the work environment.

Anticipates the internal and external implications of personal statements or actions.

Able to communicate with physicians regarding discharge planning needs of the patient.

Assists the physician in facilitating post-hospital care arrangements.

Is knowledgeable of criteria for Medicare, Medicaid, HMO, and private insurance coverage in your service area.

Possesses current knowledge of resources available within the community. Maintains a supply of resource materials for patients/family.

Communicates daily with admissions personnel regarding admission and discharge activity.

Interacts professionally with patient/family and involves patient/family in the formation of the discharge plans. Is knowledgeable of patient's financial status, diagnosis, and discharge needs.

Is responsible for home care arrangements at the time of discharge. Sets goal of completing arrangements 24 hours prior to discharge when the date and time of discharge is known.

Gathers and communicates information to insurance carriers on the member’s clinical status and ongoing care needs to secure reimbursement for services provided.

Collaborates with the Business Office and onsite eligibility worker, where patients require assistance with financial matters.

Actively participates in committees and meetings as assigned.

Consults other departments to collaborate on patient care and performance improvement activities.

Documentation meets current standards and policies.

Performs other duties as assigned and appropriate.

Customer Service - Star Standards

Service: Responds to others in an honest, professional, and positive manner. Never rude or discourteous.

Protects patient privacy, dignity and modesty in all actions and conversation. Maintains patient/co-worker privacy.

Attitude/Accountability: Greets and introduces self by name to customers/patients and families with a smile, eye contact and a kind word. Shows respect.

Makes appropriate referrals to Transitional Care services for patients frequently readmitted. Collaborates with Transitional Care leadership to review data trends.

Respects and follows Hospital specific quality, safety, and compliance standards.

Helpful and willing to assist patients and visitors.

Teamwork: Cooperates, shows support and appreciation to co-workers, volunteers, and vendors for the benefits of the customer/patient, their family, and the Hospital as a whole.

Assist others, even if it is not your job. Doesn’t say, it’s not my job or my customer/patient.

Pitches in to promote cleanliness and appearance of Hospital.

Treats co-workers with respect and professionalism.

Greets and introduces self by name to customers/patients and families with a smile, eye contact and a kind word. Shows respect.

Is a positive role model reflected by ethical behavior and task accountability?

Smiles, is an ambassador of the hospital in/outside the workplace.

Professional in appearance, behavior, and positive attitude.

Responsiveness: Courteously responds to customer/patient, visitor and co-worker needs and requests in a timely manner.

Keeps customer and families informed of all wait times and delays.

Answers call lights – acknowledges in person and responds in a timely manner.

Uses listening skills to respond to all inquiries appropriately, giving full attention, showing empathy, and understanding.

Responds quickly to requests, complaints, and questions.

Ability to turn a negative situation into a positive experience.

Steward Health Care is an Equal Employment Opportunity (EEO) employer. Steward Health Care does not discriminate on the grounds of race, color, religion, sex, national origin, age, disability, veteran status, sexual orientation, gender identity and/or expression or any other non-job-related characteristic.

Application Instructions

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