The Care navigation program manager is responsible for the developing, implementing and evaluating operational plans for care coordination activities. The primary role is to work with outpatient clinics, business planning, and information services teams to successfully implement a standard practice of case management for high risk patients that meets regulatory requirements and produces improved outcomes. The role includes building relationships with key stakeholders to operationalize programs, establish effective workflows, and ensure consistency in practice throughout the organization. The role requires strong project management, communication, and team building skills.
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1. Develops, implements, evaluates operational plans for care coordination activities, in partnership with director of care coordination, the information services team, and clinical teams. Manages day to day operations of the department. Maintains a working knowledge of case management and utilization review functions
2. Recruits, trains, evaluates, develops, disciplines and as necessary terminates subordinate staff.
3. Serves as a representative when appropriate on programmatic, departmental, hospital, community, quality teams and advisory groups related to care coordination activities.
4. Leads effective project teams and manages change to implement improvements to workflows, services, communication, information exchange, and collaboration.
5. Works collaboratively and promotes multidisciplinary communication with all members of the health care team including external partners such as payers, community organizations, schools, and referring physicians.
6. Assists in defining, collecting, analyzing information to assess the program’s effectiveness and timeliness of services and treatments according to best practice standards. Analyzes patient and aggregate variances and identifies opportunities to enhance access, efficiency, quality and patient satisfaction.
7. Assist in the development of new programs and interventions that address clinical, financial, operational, and regulatory imperatives.
8. Acts as a coach, role model, and/or mentor for clinical and non-clinical staff in the performance and documentation of care coordination activities throughout the organization. Provides formal and informal education on the practice of case management to teams and individuals across the organization.
9. Assists in creating and maintaining standard documentation and performance of care coordination.
10. Incorporates valid evidence, industry best practice, and research findings to revise standards, implement corrective actions, improve services and develop policy and procedures.
11. Develops working relationships with key stakeholders.
12. Participates and contributes to strategic planning.
13. Participates in capital and expense budget planning which support the delivery of quality, cost effective care.
14. Coordinates the assignment of resources, including staff coverage.
15. Assumes responsibility for the operation of the department in the Directors absence as needed.
1. Master’s degree in Nursing required.
2. Active, unrestricted State of Ohio nursing license.
3. Three to five years of case management or care coordination experience preferred.
4. Certification in case management preferred.
5. Advanced use of MS office applications, EPIC, and databases required.
6. Excellent communication, interpersonal and organization skills to effectively interact with medical staff, consultants, external professionals, administrators and employees at all levels.
7. Leadership ability as demonstrated through high level of initia¬tive, decision-making and organizational skills. Ability to work and problem solve with minimal supervision; ability to adapt to change positively.
8. Must be able to see, hear, speak, read and perform manual tasks with or without accommodation, and care for oneself with little or no difficulty.
9. Must demonstrate accountability for personal/professional growth by reviewing current literature, participating in professional organizations, and attending education programs.