Company Statement

Careers at AdvantageCare Physicians: At AdvantageCare Physicians, our providers and care teams reflect our commitment to population health. Improving the health of our patients is our goal; keeping our patients healthy is our commitment. Using our state-of-the-art electronic medical record (EMR) system, our providers, care teams, and practice administration staff work together to deliver high-quality, comprehensive and convenient care to our patients.

 

To protect the health and safety of our workforce, members, patients, and the communities we serve, the EmblemHealth family of companies require all new employees to be fully vaccinated for COVID-19. Exemption/reasonable accommodations may be granted because of 1) a qualifying medical condition or disability that makes getting the vaccine unsafe for the individual, or 2) objection on the basis of sincerely held religious beliefs and/or practices.

Manager, Case Management

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Professional / Leadership
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220HD Requisition #
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Administrative duties – 50% of time: Responsible for the day to day operation and performance of the case management team providing case management services to patients. Provides clinical leadership for all case management programs (hospital outreach and other programs such as transitional care) by serving as an educator, role model, patient advocate, and change agent to enhance patient care and staff proficiency. Collaborates with other departments including clinical quality & clinical innovation to evaluate and coordinate activities and programs in support of delivery of patient healthcare needs. Manages daily case management team operations and provides strong leadership through training, coaching, teaching, and managing assigned team members and programs.

Clinical duties – Initially 50% of time: Provides in-person and/or telephonic Case Management services to identified high risk PHSO (Population Health Service Organization) patients within the community including but not limited to Physician Practices and Neighborhood Care Centers. Consults with patients on their medications and durable medical equipment, reviewing care plans, addressing home care needs, and connecting members to community resources. Collaborates with primary care physicians and other providers to ensure there are no gaps in care, to improve health care outcomes and appropriate and timely utilization of services across the continuum of care. Collaborates with patients, providers, and caregivers to ensure positive care outcomes during care transitions.

Responsibilities

  • Monitors, documents, and tracks care team performance to ensure patients are engaged in a timely fashion and that performance metrics (hospital admissions, emergency room  utilization, etc.) meet or exceed established thresholds.
  • Provides ongoing monitoring, evaluation, support, and guidance to the coordination of the patient's health care. Provides patient education to assist with self-management, educate  on disease processes, and encourage healthy lifestyle changes.  Includes patient and family as appropriate. Engages actively with the primary care provider) (PCP)/designee.
  • Manages and provides clinical guidance to all case management programs based on accepted principles of nursing, social work, gerontology, geriatrics, and case management.  Facilitates relationships to foster the coordination of care across the whole continuum of care.
  • Develops programs and processes for population management of high risk and moderate risk patients.  Identifies patients who need services in alternative settings to save avoidable hospital admissions. Develops and maintains professional networks and individual relationships with physicians and other providers/vendors to promote continuity and quality of care.
  • Assists with providing updates and attends meetings with clients, collaborates with staff and leadership to develop and implement systems that support operations and business goals within identified areas of responsibility as indicated, and handles escalated issues when necessary.
  • Manages and monitors case management staff and department activities to evaluate the productivity and quality of programs and processes to identify potential improvements and to ensure maximum performance.
  • Develops, manages, and participates in departmental projects, workflow processes, and policies and procedures in collaboration with internal and external stakeholders.
  • Ensures that discharged patients receive the necessary services and resources, including medication reconciliation and coordinates services such as home health and DME, as needed.
  • Conducts case auditing of staff and implementation of performance improvement plans. Identifies opportunities for business process improvements and leads implementation.
  • Maintains staff levels, interviewing and hiring employees and administering disciplinary actions and employee performance reviews. 
  • Engages with patients in support of their treatment team to identify and establish attainable goals that positively impact clinical, financial, and quality of life outcomes.
  • Assesses the needs of patients, aligns them with the appropriate member of the care team (wellness team, registered dietitian, social worker) and develops a patient-centric care plan.

Qualifications

  • Bachelor’s Degree in Nursing
  • Current, unencumbered New York State Registered Nurse license
  • Master’s Degree preferred
  • CCM (Case Management Certification), but consideration will be given for current enrollees
  • Minimum of 5 years clinical experience as a RN 
  • Minimum of 3+ years’ experience leading case management teams, with the ability to partner with staff to build high-performing teams
  • Excellent written and oral communications skills.
  • Strong problem solving and strategy execution abilities.  Able to analyze problems and deploy strategies to improve performance in collaboration with the leadership team. 
  • Strong working knowledge of Microsoft Office applications including proficiency in MS Word and Excel and the ability to create word documents and spreadsheets
  • Proficiency in the use of EMR (Electronic Medical record) systems
  • Ability to work with minimal supervision
  • Ability to manage metrics, multi-task effectively, manage deadlines and task-oriented projects
  • Detail oriented and organized 

EEOC Statement

We are committed to leveraging the diverse backgrounds, perspectives and experiences of our workforce to create opportunities for our people and our business. We are an equal opportunity/affirmative action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, protected veteran status or any other characteristic protected by law.

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