Case Manager - PHO

Location: Beverly, MA
Job ID: 153808-1A
Date Posted: Mar 7, 2019

Job Description

Welcome To

Beverly Hospital  is part of a vibrant and growing health care system, recognized as a trailblazer in medicine and a standard bearer in patient experience. It includes an award-winning academic medical center, a superb constellation of community hospitals, home care services, rehabilitation facilities and more.

We are committed to attracting, developing and retaining top talent in a market long recognized and revered as a global leader in health. With a team approach to care, we encourage learning and growth at all levels, and we offer competitive salaries and benefits. We adhere to the principles of a just and fair work environment for all colleagues, where respect is foundational and performance is rewarded.

About the Job

Beverly Hospital, A member of Lahey Health, promotes the culture and philosophy which enables employees to give and receive the best of care.  You can become a part of the team that achieves this success through our CREATE values of Compassion, Respect, Excellence, Accountability, Teamwork, and Empathy. 

Position Summary:

Lahey Clinical Performance Accountable Care Organization (LCP-ACO) participates in a contract with Medicare & Medicaid Services (CMS) to manage the Medicare population attributed to Lahey providers. This contract includes ensuring savings are attained through achievement of quality measures, improving care coordination and providing care that is appropriate, safe and timely.   Lahey Clinical Performance Network (LCPN) has oversight of population health and is responsible to ensure that quality, efficient care management services are provided to the Lahey provider’s ACO Medicare high risk population.

The Care Manager, ACO Medicare Population provides transitional and ambulatory care management services to the Lahey primary care physicians focusing on the high risk, high cost, chronic/complex condition patient population. Collaborates with the primary care team to develop care plans on their high risk patient population through care coordination, disease management education and community resource support while enhancing care transitions across the continuum of care. Responsibilities include working with physicians, patients, families, and the multidisciplinary team in the acute care, rehab, skilled nursing facility, homecare, community and physician practice setting to optimize quality and efficient outcomes; and decrease total medical expenses. The care manager assesses, plans, implements, coordinates, monitors and evaluates options and services to meet the individual patient needs. The care manager works closely with the primary care provider  and patient to develop collaborative care plans to improve self-management of chronic condition utilizing evidence-based best practice standards. The care manager builds relationships with the patient through use of motivational interviewing techniques to promote engagement in healthy behavior.

The Care Manager ACO Medicare Population upholds the current standards of professional case management practice, and reports to the Director, Ambulatory Care Management, LCPN.

 

Scheduled Hours

40 hours per week, day shift.

Qualifications

Education:

BSN required. Masters in a health or business field desirable.

Licensure, Certification & Registration:

Active, unrestricted Massachusetts Registered Nurse License required.

Certification in Case Management (CCM) preferred.

Must be willing to achieve case management certification (CCM) within 16 months of employment.

Experience:

  1. RN with BSN and 5 years minimum of both case management and nursing experience.
  2. Excellent clinical, interpersonal and communication skills. Must be able to work collaboratively with other healthcare professionals as well as independently. Experience with coaching while working with the chronic, complex population in a physician management service organization is desirable.
  3. Must be proactive, assertive, and possess creative problem solving skills.
  4. Experience with Medicare population in managed care, medical home or integrated case management environment is preferred.
  5. Must be proficient in computer skills, internet, information technology and electronic medical record use.
  6. Achieves and maintains case management certification within 16 months of employment.

Skills, Knowledge & Abilities:

  1. Strong development, analytic and systems building skills.
  2. Must be facile with physician relations, developing systems and procedures, developing and operating a capitated managed care infrastructure, continuous quality improvement, human resources management and fiscal management.
  3. Excellent written and verbal communication skills. Must have a professional demeanor and the ability to deal with physicians, senior management, and local industry.
  4. Capable of serving as a spokesperson and leader of the integration process and communicate the vision to others in the community.
  5. A well-defined style that demonstrates confidence, maturity, self-motivation, high energy, collaboration, high intellect and leadership qualities.
  6. Excellent interpersonal skills, be an appropriate risk taker, politically savvy, diplomatic, able to deal with ambiguity, flexible, organized, results oriented, a hard worker, a quick study, good with details and have integrity.
  7. Ability to function as a facilitator who can further the organization to serve the evolving Network.