Job Summary:
Responsible for overseeing the Quality Department care management services, including case managers and community health workers. The manager ensures patients receive the proper care and service from the case manager they are assigned to.
Job Duties:
- Reviews case manager and community health worker files, case notes, outcomes, and logged progress to ensure patients are properly cared for and tracked. Reviews and audits case management services provided to patients to ensure standardized delivery of such services. Provides feedback and corrective action reports to staff.
- Helps to coordinate and oversee therapies, evaluations, and treatment objectives that are developed by the case manager in partnership with the patient’s clinician.
- Development and implementation of systems, in alignment with UT Health San Antonio’s policies and procedures and principles, to enhance clinic operational efficiency and delivery of services to patients. This includes identifying a decreasing unnecessary redundancy in clinical care management processes. Assists with overseeing the daily workflow of the Quality staff in the clinic to ensure established clinic workflows are being followed.
- Provides ongoing staff training within a specific office regarding the technical and patient management dimensions of UT Health San Antonio’s management system, including effective integration of information, technology, and treatment.
- Provides senior management with reports and analysis of case management reports.
- May be involved with providing case management services directly to patients.
- Assists with the implementation of policies and procedures regarding medical case management and provide leadership for staff by modeling expectations and behaviors.
- Maintains compliance with federal and state regulations and contractual agreements.
- Coordinates and communicates medical service functions with other departmental functions.
- Assists staff with computer systems issues related to case management.
- Conducts telephonic reviews of cases with clinicians, hospitals, and other providers.
- Responsible for staff scheduling, employee evaluations, and resolving staff conflicts. Assigns cases, maintaining appropriate staffing ratios. Responsible for hiring staff and checking credentials, license requirements, and certifications.
- Assures that documentation meets guidelines for timeliness and accuracy.
- Assures that case plan goals, permanency goals for patients, and other appropriate services are established and achieved in a timely manner.
- Oversees case managers as they develop plans for UT Health San Antonio and Regional Physicians Network patients. This includes, but is not limited to, setting schedules and routines, arranging resources, coordinating services, providing advocacy, evaluating treatments, intervening in crisis, and providing general support.
- Meets regularly with CVO/ACO CMO to provide updates on activities in Quality and Care Management, assists in communications, and assists as needed in organization and tracking of Population Health and Value-Based Care activities.
- Network Development, Physician Recruiting, and Retention as directed by CVO/ACO CMO.
- Performs other duties as assigned.
Education:
Bachelor's degree in a work-related field/discipline from an accredited college or university is required. RN/APN degree from an accredited university is required.
Experience:
Five (5) years of progressively responsible and directly related work experience is required.
Licenses and Certifications:
RN - Registered Nurse - State Licensure and Compact State Licensure and CCM - Certified Case Manager
Supervisory Requirements:
Has the authority to direct the work of others, hire or terminate employees, or provide recommendations as to the hiring, terminating, advancement, promotion, or any other change of status of other employees.