Job Board | Manager Case Management

Opening for a Director of Care Management

Wheaton Franciscan Healthcare (Availability: Immediate)

The Cient

Our client, Wheaton Franciscan Healthcare is one of the largest integrated healthcare delivery systems in Wisconsin. They currently employ nearly 12,000 employees and are Wisconsin's second largest private employer. Their organization provides nearly one quarter of the total healthcare delivered in Southeastern Wisconsin. The system consists of four major acute care hospitals, a heart hospital, transitional and extended care facilities, a home health and hospice agency, a full service medical laboratory, physician clinics, a large behavioral health program and physician services corporation, which includes a primary care physician organization. Wheaton Franciscan Healthcare is focused on its mission and values, which emphasize the respect and dignity of patients, employees and the communities they serve.

Mission

The Wheaton Franciscan System is committed to living out the healing ministry of Jesus by providing exceptional and compassionate health care service that promotes the dignity and well being of the people they serve.

The Location

The position is located in Milwaukee, Wisconsin. This is a highly desirable location with outstanding cultural, recreational and educational opportunities.

The Position

The Director of the Care Management Department holds a leadership role which is expected to work collaboratively with Hospital Administration, VP-MA's, Physician Advisors, CNO, QI, their hospital directors and staff, to carry out the Wheaton Franciscan Healthcare Mission and the goals of the Care Management Department. This role promotes leadership for the Care Management Team members to ensure that patients receive the highest quality care in the right place at the right time. The Director will help staff in achieving positive clinical and organizational outcomes and provide leadership development to Nurse Case Managers, Clinical Social Workers, UM Nurses, Discharge Planners and Clinical Documentation Specialists. The Director must have the ability to intervene when needed to address issues/barriers that interfere with quality cost-effective care.

Prerequisites

1. A minimum of a Bachelor's degree in either Nursing or Social Work is required as well as completion of a Master's Degree in Nursing or Social Work. However, the commitment to enroll within one year of hire and complete within five years is acceptable.

2. A minimum of two years experience with case management concepts and applications as well as two years experience with UM concepts and applications. Candidates must have a strong background in acute care in a hospital setting with a strong preference for management experience.

3. Strong computer knowledge relating to basic Windows applications, Excel, Power Point, systems applications (SDK, Outlook) and internet understanding.

4. Must have excellent verbal and written communication skills

5. A high level of organizational skills with an ability to prioritize activities is a must.

6. Excellent interpersonal skills are needed with the ability to interact with other department heads and staff.

7. An ability to build trust and deal with issues as they arise in a fair but firm matter.

8. Ability to conduct meetings effectively as required.

Position Responsibilities

1. Operationally responsible for the performance of the Care Management Department team members including Case Managers, UM Nurses, Clinical Social Workers, Discharge Planners, Clinical Documentation Specialists and support staff.

2. Leads implementation of strategies as directed at improving care coordination, efficiency, and throughput of care.

3. Collaborates with other health care professionals to identify needs that the Care Management Department can address to assure quality patient outcomes and cost effective care.

4. Uses a data driven approach to managing change, care coordination, LOS and outcome targets.

5. Collaborates with other Department Directors, Physicians and staff as needed to promote high quality cost effective care in the appropriate setting.

6. Monitors the work of the Care Management Team members. Mentors, coaches and supports members to enhance performance.

7. Facilitates effective education and mentoring to staff to ensure work of this department is performed at a consistently high level.

8. Financial Management and Viability: With the assistance of assigned financial staff, reviews periodic financial statements and reports, and makes changes in resource allocation, spending, and other relevant business activity to ensure the financial viability and budget compliance.

9. Human Resources Management: With the support of and in coordination with the WFH Human Resources and Organizational Development function, maintains positive personnel relations and strives to make WFH an employer of choice by ensuring that associate questions and concerns are addressed responsively. Ensures compliance with laws and regulations and adherence to WFH HR/OD policies and procedures. Ensures that performance management programs for staff and physicians are effectively administered and that all staff receives on-going feedback and coaching on job performance.

10. Compliance and Privacy: Ensures that policies and procedures of WFH regarding corporate compliance and privacy of patient and associate information are observed. Personally models professional confidentiality and discretion in all communications and exchanges of information

11. Supervisory Practices: Carries out normal supervisory duties and responsibilities, such as interviewing and hiring subordinates, conducting performance appraisals and granting merit pay increases, adjudicating requests for time off or other associate requests, adjudicating formal grievances or responding to other individual associate concerns, recognizing associate accomplishments, etc. Carries out other duties and special assignments as delegated by the Administrative Director of Care Management.

12. WFH Values and Leadership Competencies: Demonstrates a visible working style, acts in a manner that is consistent with and shows commitment to the WFH Values and leadership competencies.

Availability

Immediate

Contact Person

Susie Anshus

Executive Recruiter

Flannery & Associates, LLC

N27 W23953 Paul Road, Suite 204

Pewaukee, WI 53072

(262) 523-1206 ext. 11

Fax (262) 523-1873

www.flannerysearch.com

susie@flannerysearch.com

| Posted on January 26, 2010 |

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EMERGENCY DEPARTMENT CASE MANAGER

Johns Hopkins Hospital

You have many choices in today's nursing market. Whatever stage you are in your nursing career, Johns Hopkins Nursing has a place for you. The spirit of collaboration, teamwork and empowerment you will know as a Johns Hopkins nurse is a unique experience. At Johns Hopkins, you can enjoy the support of a team while maintaining your individuality.

The Johns Hopkins Hospital has been ranked #1 among the Best Hospitals by U.S. News and World Report for the 19th consecutive year. We are currently recruiting for an Emergency Department Case Manager. The Emergency Department Case Management model is designed to optimize the appropriate utilization of resources through identification and alignment of patient care services resulting in improved clinical quality and efficiency outcomes.

Responsibilities:

-Demonstrates expertise as a clinical practitioner and skilled manager of clinical systems that impact patient care

-Performs clinical assessments and monitoring of level of care appropriateness for ED visits as well as inpatient admissions

-Coordinates interdisciplinary patient care as established by clinical guidelines, managed care contracts and individualized plans of care

-Mobilizes resources and manages systems in order to respond to clinical and efficiency outcomes of care

-Partners with Social Work to identify psycho-social needs and appropriate discharge plans through alignment with available community resources

-Identifies opportunities to expedite patient care delivery to improve Emergency Department throughput

Requirements:

-Master's of Science in Nursing

-Minimum three years Emergency Department experience

-Available to work day/evening shifts

The Johns Hopkins Hospital is an institution like no other. We invite you to discover the difference of being a Johns Hopkins nurse by applying at www.hopkinsnursing.org and refer to req. number 19631.

A respected past, an exciting future. Be part of the legacy.

EOE/AA, M/F/D/V The Johns Hopkins Hospital and Health System is an equal opportunity/affirmative action employer committed to recruiting, supporting, and fostering a diverse community of outstanding faculty, staff, and students. All applicants who share this goal are encouraged to apply.

| Posted on January 22, 2010 |

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CASE MANAGEMENT OPPRTUNITY IN DELAWARE

HealthWays

Company Overview

For the past quarter century, Healthways has fostered a creative culture of care, invention, and inspiration. The pace is fast, and the energy is high. Unlike any other healthcare company, Healthways drives the vision of health by empowering and enabling people to realize their personal best.

As a fast growing company, Healthways has an eye firmly on the future. We offer a wide spectrum of proven services that reach millions of individuals worldwide by phone, mail, internet, or face-to-face and are offered both domestically and internationally.

Job Description

RN - Provider Services Liaison

The Provider Services Liaison, with the support and guidance of the Provider Services Senior Liaison and the Manager of Clinical Operations and Outcomes, is responsible for delivery of services in support of attaining specific outcomes as dictated by Healthways product design and specific health plan contractual obligations. Specific services are to assist the provider network in achieving optimal, cost-effective total health care management to the population of disease program members and supporting Providers with workflow integration/collaboration opportunities with Healthways. Specific Provider Services Liaisons objectives consist of the following:

Ø Marketing of program/product specific interventions to designated provider network.

Ø Development and maintenance of successful relationships with both internal and external stakeholders.

Ø Providing expert clinical consultative support to provider network, in the form of best practice guidelines, education tools, outcome reports, and practice assessments, resulting in action plans that optimize outcomes and ensure value proposition.

Ø Serving as professional liaison between all external customers (i.e. physicians, health plan representatives, home health services, etc) and the Healthways' customer service team.

Ø Identifying opportunities to improve on standards or guidelines of care in the clinical setting and collaborating with stakeholders in achieving positive clinical outcomes.

RESPONSIBILITIES INCLUDE:

Maximizing Effectiveness of Provider Services Liaison Interventions to Assure Contractual Clinical and Financial Outcomes

1. Act as a catalyst to build and maintain strong relationships with primary care physicians, in order to support member behavior change and improve outcomes

2. Integrate fully with BCBSD customer (provider networking, disease management, QI) to ensure that knowledge is shared regarding office visit appointments.

3. Assist PCP offices with integration with Healthways clinicians on Physician Integration initiatives including development of patient registries, tracking processes, patient self-management support, implementation of clinical practice guidelines and work process/patient flow improvements.

4. Describe the predictive model to PCP's and explain how members are grouped according to risk levels.

5. Evaluate how integration between Healthways and PCP office is working and suggest, create, and implement new tools to improve the process.

6. Implement Provider Services Liaison interventions according to the clinical delivery model of the product delivered, and provide training to office staff, as needed, to achieve clinical and financial outcomes.

7. Demonstrate clinical expertise with regard to chronic disease management.

8. Participate in the development and implementation of Provider Services Liaison marketing strategies and tools that reflect market need and contribute to the achievement of company goals.

9. Participate in a team approach to decision-making practices/strategic planning with all internal/external customers, including Provider Services Liaison team, account team, and health plan.

10. Ensure processes for ongoing assessment of provider network needs are implemented to support quality improvement strategies and promote provider satisfaction.

Leadership and Training Responsibilities:

1. Provide physician and staff education to ensure understanding that facilitates delivery of the standards/guidelines for care with regard to specific chronic diseases/conditions.

2. Provide physicians with results of individual panel outcomes and assist in developing action plans in support of quality improvement.

3. Serve as direct liaison in support of relationships with all external customers to facilitate understanding of program objectives and ensure customer satisfaction.

4. Coordinate all physician advisory committee activities including recruitment, meeting planning, and record keeping as defined by the Healthways Customer Service Team.

5. Participate in quality improvement activities, initiating programs as the customer (health plan or employer group) and Healthways needs are identified.

6. Identify systemic and individual provider opportunities for improvement impeding goal achievement and conduct interventions to remove and/or reduce identified barriers.

7. Review pertinent literature and research regarding population management principles for members with chronic diseases and share the information with physicians and their staff.

8. Provide leadership and mentoring to new Provider Services Liaison colleagues.

9. Participate in marketing of Provider Services Liaison role responsibilities to all internal/external customers.

10. Support Healthways sales and marketing efforts as necessary.

11. Support Healthways operational efforts as necessary.

12. Participate in or lead multidisciplinary project team.

Data/Information Management:

Run reports regarding PCP panel of members to share with providers.

1. Conduct periodic chart data assessments to evaluate adherence to standards of care, and validate information with Healthways information system to maximize call center clinician interventions.

2. Compile data into aggregate physician practice outcome reporting that is shared with physicians to assess opportunities for improvement and implement mutually agreed upon action plans.

3. Conduct initial/ongoing physician practice assessments to proactively and cooperatively implement corrective action to facilitate quality outcomes and provider satisfaction.

4. Ensure that information shared between the CEC and the PCP offices is flowing smoothly.

The successful candidate will have outstanding customer services skills, the ability to examine, evaluate, and discuss the effectiveness of the operation center's programs in relation to patient care and the health plan account and to explain and contribute to its success. This colleague must have an instinctive ability to anticipate physician, team and customer needs, be passionate about quality of work, and diligent about performance monitoring.

The successful candidate will understand and have a commitment to the philosophy, mission, values and vision of Healthways, Inc. The qualified individual will be able to demonstrate these values with his/her leadership practices. This individual will also possess both a professional integrity and demeanor, and be a professional representative of Healthways. Strong analytical and decision-making skills, along with considerable tact and diplomacy, are extremely important.

EXPERIENCE AND QUALIFICATIONS:

1. Credentials

Healthcare background and Bachelors degree required; current licensure as an RN required.

1. Skills and Experience

Ø 5-10 years clinical experience in acute care, home health, physician office management, managed care organization, provider relations, pharmaceutical sales.

Ø Physician office experience preferred.

Ø Demonstrates advanced knowledge of chronic diseases and the principles of population management.

Ø Demonstrates experience in application of business principles to clinical practice.

Ø Sales and marketing experience preferred.

Ø Demonstrates ability to be self-directed, highly organized, multi-tasked capable, and proficient in problem solving skills.

Ø Demonstrates exceptional oral, written, and presentation skills.

Ø Demonstrates ability to work effectively with all levels of administrative and professional personnel.

Ø Demonstrates proficiency with data analysis and ability to organize data in support of reporting needs.

Ø Demonstrates ability to proactively identify and assimilate QI/QA processes into practice.

Ø Demonstrates computer competencies to include word processing, spreadsheet, presentation preparation, and data base management.

Ø Has valid drivers license and driving record showing no restrictions that would impede ability to travel by automobile.

1. Travel Requirements

Ø 80 % (variable)

About Healthways:

For three decades, Healthways has been dedicated to improving the human condition. Each year, we learn more and do more for the millions of individuals who count on us to make a difference in their health and well-being. Healthways is a global provider of solutions that help employers, health plans and government agencies enhance business performance and reduce healthcare costs. Our mission is to create a healthier world, one person at a time.

Here at Healthways as we continue to make the world a healthier place, we have also created an environment where people choose to do their best work. Our unique culture thrives on mission-driven individuals who exude a high sense of energy and passion in everything that they do. Collaboration and teamwork are an essential part of everyday life for Colleagues who trust and depend on one another to achieve the highest degree of collective success. We are an organization that strives to recruit the best and the brightest individuals who take pride in the statement "I work for Healthways."

Additional Information:

* Travel Percentage: 75%

For more info contact:

Polly Street

Healthways and the CareFirst Care Essentials Program

Office Phone: 703-815-1059

email:

| Posted on January 13, 2010 |

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