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Manager of Care Management, West Penn Hospital

Location: Pittsburgh, PA
Company: Highmark Health
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Company :
Allegheny Health Network
Job Description :
Manages, supervises, and coordinates the daily operations of a specific patient care team, providing clinical and administrative leadership and expertise. Contributes to the strategic planning process and attainment of goals of the department, the organization and network
- Responsible for implementation of mission, vision, philosophy, core values, evidence based practice (EBP), and standards of the organization, and nursing service within their defined areas of responsibility.
- Demonstrates and role models professional behavior with all staff interactions.
- Serves as change agent and role model for change to assist staff in accepting and embracing the necessary change.
- Collaborates with physician advisors and partners to share performance metrics and patient care progression goals.
- Leads organization initiatives for daily care progression huddles, prolonged stay forums, and complex care management processes.
- Conducts monthly unit conferences with minutes which include discussions of both unit and organizational activities and goals.
- Completes annual performance appraisals on associates which includes peer feedback process, plan for professional development and employee self-appraisal.
- Attends greater than 50% of leadership meetings.
- Promotes departmental shared governance process to include ongoing support through consultation and assistance in eliminating barriers.
- Promotes ongoing development of staff.
- Promotes collaborative practice within unit-based teams of social workers and nurse care managers.
- Promotes and encourages specialty certification.
- Identifies, plans, and implements activities in specified clinical departments to promote interdisciplinary collaboration on behalf of the patient and their family to ensure safe and efficient care progression, effective and appropriate transition plans, and excellent clinical and patient experiences.
- Monitors departmental performance in appropriate EBPs, quality and patient safety goals, meeting assigned goals.
- Develops action plan for any goal not met which includes timeline.
- Participates in 85% of monthly Joint Commission mock tracers.
- Develops a yearly unit based quality plan with unit based clinical practice and PI council based on identified unit needs.
- Assures departmental participation and compliance with Six Sigma (LEAN) projects goals related to through put and other quality improvement initiatives.
- Assures that department works collaboratively with patients, families, physicians, and members of the interdisciplinary clinical teams to meet established organizational goals for patient experience.
- Reviews nursing department Press Ganey report, making the connection to the care management team contributions and providing feedback to staff at monthly unit conference.
- Investigates and provides feedback for identified patient or departmental concerns.
- Rounding for Purpose weekly to assess patient and family needs.
- Develops departmental plan to address any improvement needs.
- Meet or show consistent progress toward meeting established patient experience goal(s).
- Demonstrates fiscal stewardship through effective and efficient use of staff, facilities, equipment, and other resources while maintaining patient care standards.
- Maintains both FTE and Goods/Services within established budget, completes variance reports according to established guidelines.
- Provides consistent communication and feedback related to length of stay, resource utilization, and prevalence of avoidable days.
- Coaches care management/social work teams in use of avoidable day tracking metrics, key factors in level of care determination, and variation in payor requirements.
- Utilizes established tools to monitor monthly budget performance, conducting drill down to explain variances as needed.
- Reports budget performance at monthly unit conferences.
- Fosters the development of staff through coaching, mentoring, and creating an environment which encourages learning and use of research.
- Assures appropriate orientation, education, credentialing, and professional development for personnel.
- Encourages and facilitates staff membership on evidenced-based practice/research committee, and clinical practice councils.
- Encourage and facilitate attendance at nursing grand rounds according to educational needs assessment of unit/department or network.
- Foster peer review participation with staff an d participate in peer review with other managers..
- Set professional developmental goals with staff member at yearly evaluation.
- Identifies one area for self-improvement annually and develops a plan to improve.
- MSN (Education and experience will be considered in lieu of degree)
- Current PA RN licensure
- Professional National certification
Disclaimer: The job description has been designed to indicate the general nature and essential duties and responsibilities of work performed by employees within this job title. It may not contain a comprehensive inventory of all duties, responsibilities, and qualifications required of employees to do this job.
Compliance Requirement : This job adheres to the ethical and legal standards and behavioral expectations as set forth in the code of business conduct and company policies.
As a component of job responsibilities, employees may have access to covered information, cardholder data, or other confidential customer information that must be protected at all times. In connection with this, all employees must comply with both the Health Insurance Portability Accountability Act of 1996 (HIPAA) as described in the Notice of Privacy Practices and Privacy Policies and Procedures as well as all data security guidelines established within the Company's Handbook of Privacy Policies and Practices and Information Security Policy.
Furthermore, it is every employee's responsibility to comply with the company's Code of Business Conduct. This includes but is not limited to adherence to applicable federal and state laws, rules, and regulations as well as company policies and training requirements.

Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities, and prohibit discrimination against all individuals based on their race, color, religion, sex, national origin, sexual orientation/gender identity or any other category protected by applicable federal, state or local law. Highmark Health and its affiliates take affirmative action to employ and advance in employment individuals without regard to race, color, religion, sex, national origin, sexual orientation/gender identity, protected veteran status or disability.
EEO is The Law
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Req ID: J176170
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