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About The Position
The Manager, Care Management and Complex Discharge Planning is responsible for the daily management of the C3 Care Management Program, which includes enhanced care coordination activities for MassHealth (Pediatric, Adult, and Maternal Health) Member Populations. This involves day-to-day mentoring and oversight of an interdisciplinary Care Management team, including RN care managers, Behavioral Health care managers, and Community Health Workers. The Manager also provides performance oversight to FQHC/APP (Affiliated Participating Provider) Care Management Teams to ensure high-quality, cost-effective care management services. This position oversees the Complex Discharge Planner role, supporting complex discharge planning across all FQHCs and APPs to reduce readmissions and improve continuity of care. A proficient understanding of MassHealth requirements is necessary to ensure care management workflows comply with federal and state regulations. The manager works closely with the Director of Care Management and is responsible for the performance and operational management of FQHCs/APPs participating in care management. This role is primarily hybrid, requiring occasional office-based work and in-person FQHC/APP-facing meetings.
Requirements
- 3-5 years of supervisory experience in care management in a managed care environment; experience working with a Medicaid population is strongly preferred.
- Experience using Word Office products (Excel, Word, PowerPoint).
Nice To Haves
- Pediatric, obstetrics, maternal/newborn experience highly desired.
- Familiarity with MassHealth ACO Program, Medicare Risk Contracts (REACH, MSSP, ACO-Flex).
- Familiarity with Federally Qualified Health Centers (FQHCs) or Community-Based Practices.
- Demonstrated success in leading a multi-disciplinary team, including communicating and working with Health Centers, providers, primary care teams, nurses, Community Health Workers, and other organizations/programs such as SSOs (Social Service Organizations), and CSPs (Community Support Programs).
- Ability to navigate ambiguity and utilize clinical expertise to solve complex problems.
- Ability to understand and interpret program and staff performance data analysis.
- Experience working with patients with chronic medical, behavioral, and social health needs.
- Must be flexible and adaptable to change.
- Must demonstrate excellent interpersonal communication skills, written and presentation skills.
- Familiarity with managing data, reporting, and using data driven reports to inform decision making and performance.
- Ability to positively influence others with respect and compassion, and the ability to orient, motivate and build a cohesive team.
- Experience motivating, inspiring, and building consensus across diverse staff.
- Experience using appropriate technology, such as computers and Virtual Meeting Rooms for work-based communication.
- Experience or familiarity working with CTC Epic/Epic, other EHRs, or Population Health Platforms (i.e., Arcadia).
- Experience with anti-racism activities, and/or lived experience with racism is highly preferred.
Responsibilities
- Assess and monitor team performance using program metrics, data, and management reports to assess caseloads, engagement rates, outcomes, and other process measures.
- Using data and managerial tactics, monitor staff performance, including opportunities to improve and maintain performance standards.
- In collaboration with the Director of Care Management, develop, monitor, and report performance improvement needs of staff and FQHC/APPs.
- Perform chart audits, provide staff and group supervision, and complete performance reviews, including mid-year and annual goal setting.
- Address operational needs including vacancies, participate in the hiring of staff, manage the onboarding, orientation, and training process, as well as manage Personal Time Off (PTO) coverage.
- Ensure staff are informed of policies and procedures and care management/program workflows.
- Support the development of training content, including workflow updates that reflect the most current MassHealth / CMS requirements, and participate in delivering training.
- Build effective relationships with all external stakeholders including our primary customer, FQHCs and APPs.
- Be the first point of contact for urgent needs, such as staff managing complex patient issues/complex discharge plans, member complaints, and grievance issues pertaining to care management, and escalate to Director/leadership as appropriate.
- Prepare CM performance material (PowerPoint) tailored to each FQHC/APP or aggregated for meetings such as monthly clinical performance reviews.
- Attend monthly FQHC/APP clinical performance meetings and ACO meetings, present care management program performance data, and make recommendations on areas of improvement.
- Monitor performance trends and lead structured improvement initiatives for FQHCs and APPs not meeting targets.
- Be well-versed in understanding technology tools that support the care management program, including the care management platform and Health Related Social Needs (HRSNs) screening tool.
- Ensure special initiatives such as HRSNs and Care Needs Screening (CNS) processes are integrated into care management workflows.
- Facilitate clinical rounds, coordinate/attend complex discharge planning case discussions, and participate in care management clinical forums.
- Special projects and other duties assigned.
Benefits
- PTO coverage