RN Complex Care Management Manager

Position Description Summary:

The RN Care Management (CC) Manager reports administratively to the Sr. VP for Clinical Strategy and clinically to the Medical Director of Integrated Care (MDoIC). The position provides clinical leadership and expertise in chronic disease management and care management practices. Provides direct oversight of Population Health (PH) RN staff and assures achievement of individual and team performance and productivity standards. Implements changes to effect continual improvement in services provided. Directly responsible for personnel actions including hiring, training, coaching, evaluating performance, monitoring time and attendance, and scheduling of team members. Monitors work product and division of work between team members to promote staff working at the top of the license. Develops staff in an environment that is motivating. Promotes effective communication between departments and entities, acting as a liaison to facilitate information sharing, collaborative problem solving and adequate provision of services; fosters and maintains collaborative relationships within the population health division and the organization. Knowledgeable of government payer requirements and benefits. Provides staff training to assure they remain compliant with provision of services within a variety of different payer types. Maintains skills in care coordination, disease management and patient transition management to allow for coverage during staffing shortages in the department. Performs other duties as assigned.

Strategies must align with Company's integrated Care Management continuum and complex care strategy, as well as realities of catchment healthcare care systems (physical and behavioral health (MHSUIDD) providers) contractual obligations and work flows. Core competencies include but are not limited to:

· Systems Leadership;

· Member/Member centered care;

· Evidence based best practices;

· Informatics; and

· Quality improvement.

This position may work with staff, members and family members as well as community stakeholders.

Note: This position requires access to and use of confidential healthcare information or protected health information (PHI) as described in laws addressing patient confidentiality, including, but not limited to, the federal HIPAA law, the Confidentiality of Alcohol and Substance Abuse Patient Records law, 42 CFR Part 2, and various state laws. As such, the individual filling this position shall be required to be trained regarding such laws and shall be required to observe those laws in his/her capacity as an employee of the Company. The individual filling this position shall also sign a confidentiality statement as an employee of the Company.

Essential Duties and Responsibilities: List in order of importance and Percentages equal to 100%

40%- Management:

The manager will provide supervision to CCMRN Team by observing and monitoring paperwork/documentation/data/reports to ensure that RN Complex Care Management activities are carried out within the Vaya Health catchment area in an effective manner. Participate in the development and validation of data and reporting projects relative to RN Complex Care Management activities. Work in collaboration with Complex Care Management and Care Management Strategy leadership team to identify, develop and implement ongoing complex care improvement. Provide coaching to supervisors and employees to ensure continuous improvement of performance in meeting the needs of members, Vaya Health and community partners. Conduct performance reviews as required and conduct employee trainings to include but not limited to policies and procedures and service definitions, etc.

30% Managed Care Treatment Planning Care Management:

The Manager will ensure that teams have knowledge of duties described below and carry out these duties by providing direct supervision. The Manager may provide coverage in situations that require additional support such as staff shortages or an elevated need for services.

Oversight activities include but not limited to the following:

· Team compliance with Division of Medical Assistance and Division of MHDDSAS Contract with specific emphasis on Care Management roles and responsibilities.

· Team compliance with Complex Care and Care Management Continuum and Vaya policies and procedures.

· Team Risk Management- Proactively ensures individuals identified as a Special Needs enrollee that have treatment needs or require regular monitoring have a Behavioral Health Clinical Home and a Medical Home are assigned and receives outreach in a timely way.

· Ensures through supervision and in person CCMRN skill observation, member education regarding chronic or acute conditions, medication management, and care planning (including how to avoid a medical crisis).

· Ensures person centered principles are utilized by the CCMRN and the team in care planning activities for individuals through fidelity reviews or other CCMRN quality oversight processes.

· Provides support to CCMRN in addressing barriers to care for members through convening key providers and others to address needs of the individual or populations at the individual or system level.

· Proactively works with CCMRN team to identify gaps in services and intervenes to ensure that the individuals and specialty populations receive appropriate care.

· Uses data, chart review and supervision to measures results of intervention and treatment, including reduction in high risk events and inappropriate service utilization.

· Ensures that CCMRN services for the individual are coordinated across the Company system and with other healthcare and social determinant systems.

· Appropriately escalates high-risk scenarios to appropriate leadership. High risk can involve Health & Safety of an individuals served, staff or organizational risk.

· Understand the role of and collaborate with PH Division Teams re routine care planning, discharge planning teams, transitional care plans, educating staff and members regarding network services and supports with consideration of medical necessity, funding eligibility and appropriateness of recommendations relative to person-centered, recovery principles and known best/appropriate practice.

· Ensures CCMRN Team identifies and communicates gaps in care related to network adequacy to Network Department for healthcare needs; coordinates with FastTrack process; notifies Company Network of provider contractual concerns or through established process if quality of care or health and safety concerns.

· Ensure CCMRN Team notifies and updates assigned provider if currently engaged; provides support to the CCM if provider does not engage or follow up appropriately.

· Participate in the development and implementation of best practice complex care and Care Management strategies as identified by Vaya Health; and

· Provide proactive and clear supervision supported by data to ensure individuals and teams are meeting departmental and organizational benchmarks.

· Collaborate with key stakeholders, network providers, and non-network providers with particular attention to primary care, health departments, and healthcare systems.

25% Collaboration:

The Manager will ensure team supervisors and teams to ensure organizational and community partner collaboration. This position will interface with key stakeholders and is responsible for understanding Company organizational goals, initiatives and requirements in order to effectively communicate and facilitate collaborative partnerships. This position is also expected to provide information from key stakeholder interactions to the appropriate departments and teams to improve the care continuum for

5%

Other duties as assigned.

Supervisory Responsibilities:

Population Health RN Team.

This position supervises their team by observing and monitoring paperwork/documentation to ensure that Complex Care Management activities are carried out within the Vaya Health catchment area in an effective manner. The RN CCM Manager will provide coaching to employees to ensure continuous improvement of performance in meeting the needs of members and communities. Will conduct performance reviews as required and conduct employee trainings to include but not limited to policies and procedures and service definitions. The Manager will work with employee to mediate dissatisfaction within the community.

Requirements:

Education and Experience:

An RN degree in nursing and considerable experience in behavioral health, or equivalent combination of education and experience are required.

Mental/Physical Demands:

Person in this position is required to have close visual acuity to perform activities that include viewing a computer terminal; and extensive reading. Physical activity in this position includes crouching, reaching, walking, talking, hearing and repetitive motion of hands, wrists and fingers. Sedentary work with lifting requirements up to 10 pounds, sitting for extended periods of time.

Knowledge, Skills and Abilities:

Thorough knowledge of community-based programs and eligibility criteria pertaining behavioral health, IDD and other healthcare programs; preference for Basic Life Saving certification, thorough knowledge of the policies and practices of case management/Care Management; skill in dealing with members and their families in a tactful manner; skill in the use of personal computers, related software applications, hardware and peripheral equipment; ability to maintain accurate records and files; ability to review and analyze data to assure effective and efficient use of resources, ability to communicate ideas effectively in both oral and written formats; ability to maintain the confidentiality of members; ability to establish effective working relationships with associates, members, their families, social workers, medical practices, and the general public. Ability to travel and work with members and their families in office-based, home and/or community settings.

Proficiency in Microsoft Office products (such as Word, Excel, Outlook, PowerPoint, etc.) and Company information system is required.

Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Licensure:

Must be licensed as a registered nurse in North Carolina

Driving on Company Business:

This position requires driving a personal vehicle for Vaya Health Business in accordance with 216.02 Travel Reimbursement policy and 302.0 Driver Requirements & Safety Guidelines.

Decision Making/Consequences of Error:

Decisions result in members either receiving or not receiving appropriate services or appropriate referrals for higher-level assistance as needed.

• In cooperation with Hospital Emergency Department or Inpatient Discharge planning teams, participate in developing transition plans, educating staff and members regarding network services and supports with consideration of medical necessity, funding eligibility and appropriateness of recommendations relative to person-centered, recovery principles and known best/appropriate practice.
• Develop, coordinate and link emergency discharge services (up to and including residential placement based on medical necessity, funding, and service definitions or EPSDT for children/youth) for members who are inappropriately discharged from residential facilities (child or adult); coordination with FastTrack process; notifying Company Network of provider contractual concerns or through established process if quality of care or health and safety concerns;
• Notification and update of assigned community-based Care Manager (CM) if member is currently assigned;
• Transition to community-based CM post-discharge;
• Participate in the development and implementation of best practice complex care strategies as identified by Company;
• Provide proactive and clear supervision supported by data to ensure supervisors and teams are meeting departmental and organizational benchmarks; and
• Collaborate with key stakeholders, network providers and non-network providers with particular attention to crisis, inpatient, 3-way bed contracts, NC START, etc.

• Proactively ensures that members identified as eligible for Company CM that have treatment needs or require regular monitoring have Behavioral Health services and supports and linked, at a minimum, to primary care.
• Ensures that the care plan includes a transition plan and ensure it is developed by care team or, if necessary, by the Acute Response CM to meet needs and to access care for the individual.
• Convenes key providers and others to address needs of the individual, ideally in person or telephonically while member is still in facility.
• Identifies gaps in services and supports, intervenes to ensure that the member receives appropriate care and can access that care.
• Measures results of intervention and treatment, including reduction a high-risk events and inappropriate service utilization.
• Ensures that services are coordinated across the Company system and with other systems, including primary care.
• Provides clinical transition planning assistance to local hospitals, and coordinates with hospital liaisons when applicable, and tracks members discharged from state and local hospitals to ensure they follow up with aftercare services and receive needed assistance to prevent further hospitalizations.

• CM Platform basics
• Outreach & Engagement
• Release of Information practices
• Health Risk Assessment
• Medication List and Continuity of Care process
• Care Planning
• Interdisciplinary Care Team and Ongoing Care Management

Mental/Physical Demands: 

• BH I/DD Tailored Plan eligibility and services
• Whole-person health and unmet resource needs (ACEs, Trauma, cultural humility)
• Community integration (Independent living skills; transition and diversion, supportive housing, employment, etc.)
• Components of Health Home Care Management (Health Home overview, working in a multidisciplinary care team, etc.)
• Health promotion (Common physical comorbidities, self-management, use of IT, care planning, ongoing coordination)
• Other care management skills (Transitional care management, motivational interviewing, Person-centered needs assessment and care planning, etc.)
• Serving members with I/DD or TBI (Understanding various I/DD and TBI diagnoses, HCBS, Accessing assistive technologies, etc.)
• Serving children (Child- and family-centered teams, Understanding of the “System of Care” approach)
• Serving pregnant and postpartum women with SUD or with SUD history
• Serving members with LTSS needs (Coordinating with supported employment resources

R.N., House Supervisor

We are seeking House Supervisors to join our team! Staff functioning as a House Supervisor will provide administrative supervision in the workflow, resource utilization, and bed management for assigned clinical and non-clinical departments. Successful candidates will demonstrate the ability to support the psychological and physical support of patients, visitors, and coworkers. This would include responding to organizational emergency situations, initiating disaster notification processes, handling patient placement on both campuses and, would escalate assistance as appropriate. House Supervisors will be responsible for understanding the resources needed to resolve problems, and when to use them in order to facilitate organizational operations.    

What You'll Need:    

• Current Colorado Registered Nurse Licensure.    
• A Bachelor of Science in Nursing (BSN) is required. Candidates with a degree in progress, or who make a commitment to begin within 6 months of hire may also be considered.    
• High level of critical decision-making ability.    
• BLS, ALS, PALS, and Neonatal Resuscitation certifications.     
• At least 2 years of experience in an acute care setting is preferred.    

What You'll Do:     

• Strong understanding of nursing in accordance with law, policies, procedures, and standard practices.    
• Assess and interpret overall staffing effectiveness for the appropriate number, competency, and skill mix in the provision of health care services according to census, acuity, and responsible use of labor budget.     
• Serve as a professional resource to patients, families, providers, and staff by prioritizing, mediating, and resolving concerns.     
• Maintain nursing standard of care and assist with writing and updating policies and procedures.    
• Demonstrates an expectation for support and quality improvement through quality metrics.     
• Ability to build rapport and coordinate team problem-solving methods.    
• Act as a liaison with administrative and facility directors.     

We Take Care of Our People

As the largest employer in the San Luis Valley, we strive to provide our employees with high-quality, robust benefits to balance great work with a great life.  To show our appreciation of your hard work, we offer the following benefits and perks:

• Medical, dental and vision plans to suit the needs of you, your family, and lifestyle.
• Paid Time Off and Sick Leave programs.
• Free life insurance benefits for full-time employees with the opportunity for eligible employees to purchase additional coverage.
• Education program to foster your growth and development.
• Opportunities to volunteer and give back to the community.
• Cell phone discounts, ski/snowboard lift ticket discounts, Dell Computer discounts, local pool discounts, gym discounts, and more!
• On-site employee workout center.

Registered Nurse, Float Pool

We're seeking Registered Nurses to join our Float Pool! Individuals in this role will provide nursing care to all patients in the assigned unit, demonstrating the ability to triage and assess patient needs to ensure adequate care and nursing standards are met, observes and initiates appropriate nursing treatments, and reports symptoms and conditions of patients to treating providers.  Additional tasks include assisting providers with invasive procedures, administering medications, documenting, and assisting other staff members as required to ensure quality care is provided to all patients.  

A sign-on bonus/ relocation assistance is available for the selected qualified candidate.

What You'll Need:   

• Current Colorado Registered Nurse license  
• Certifications in Basic Life Support, Advanced Life Support, Pediatric Advanced Life Support, Neonatal Resuscitation Program. 
• Two years of nursing experience

What You'll Do:   

• Assisting, planning, implementing and evaluating the delivery of care to accepted nursing and hospital standards  
• Administering prescribed medications and treatments in accordance with approved nursing techniques.  
• Maintaining awareness of comfort and safety needs of patient.  
• Observing patient, records significant conditions and reactions, and notifies physician of patient's condition and reaction to drugs, treatments, and significant incidents.  
• Responding to all situations based upon nursing standards, policies, procedures, and protocol.  
• Documenting nursing history and physical assessment for assigned patients.  

We Take Care of Our People

As the largest employer in the San Luis Valley, we strive to provide our employees with high-quality, robust benefits to balance great work with a great life.  To show our appreciation of your hard work we offer the following benefits and perks:

• Medical, dental and vision plans to suit the needs of you, your family, and lifestyle.
• Paid Time Off and Sick Leave programs.
• Free life insurance benefits for full-time employees with the opportunity for eligible employees to purchase additional coverage.
• Education program to foster your growth and development.
• Opportunities to volunteer and give back to the community.
• Cell phone discounts, ski/snowboard lift ticket discounts, Dell Computer discounts, local pool discounts, gym discounts, and more!
• On-site employee workout center.

R.N., Operating Room - Surgery

Are you a detail-oriented registered nurse who enjoys critical thinking and wants to take your skills to the next level? We are looking for an Operating Room Registered Nurse to be responsible for the day-to-day activity in the operating room at San Luis Valley Health. Be the coordinator and ensure the provision of safe quality patient care.

What you need:   

• Bachelors of Science preferred, Associates Degree in nursing required.    
• Current RN license with the State of Colorado Board of Nursing
• Basic Life Support, Advanced Life Support and Pediatric Advanced Life Support required.  
• Computer experience required secondary to the electronic medical record and email  
• One year nursing experience preferred.

What you'll do:

• Assist, plan implement and evaluate the delivery of care to accepted nursing and hospital standards relevant to surgery or operating room standards.
• Assist with surgical procedures and scrub as required.
• Observe patients, records significant conditions and reactions, and notifies physician of patient's condition and reaction to drugs, treatments, and significant incidents.
• Daily monitoring of the activities of assigned staff, assisting with the orientation and teaching of new employees in the clinical setting with the assistance of the nursing education department.
• Assure compliance with all State and Federal regulations and the mission and philosophy of San Luis Valley Health.
• Interface with multidisciplinary teams including physicians to identify and resolve operational issues and/or needs.
• Ensure counts are done per policy, sterile procedure is followed at all times, surgical time-outs are consistent and effective, and the overall functions within the operating room meets the standards outlines by all regulatory bodies and the Association of Operative Registered Nurses.

We Take Care of Our People

As the largest employer in the San Luis Valley, we strive to provide our employees with high-quality, robust benefits to balance great work with a great life.  To show our appreciation of your hard work we offer the following benefits and perks:

• Medical, dental and vision plans to suit the needs of you, your family, and lifestyle.
• Paid Time Off and Sick Leave programs.
• Free life insurance benefits for full-time employees with the opportunity for eligible employees to purchase additional coverage.
• Education program to foster your growth and development.
• Opportunities to volunteer and give back to the community.
• Cell phone discounts, ski/snowboard lift ticket discounts, Dell Computer discounts, local pool discounts, gym discounts, and more!
• On-site employee workout center.