CARE DELIVERY MANAGER - Prologic Cosulting Inc

JOB PURPOSE:

Responsible for supporting the nursing standards of excellence with advanced professional education to deliver high-quality care. Serve the organization as a member of the management team, working alongside all departments and employees to support and oversee the day-to-day operations. Provide guidance, and deliver best practices in achieving the organization's objectives, goals, and mission. Cultivate an environment dedicated to improving experience, enhancing satisfaction and retention. Provides care coordination in a manner that is sensitive to age, gender, sexual orientation, cultural, linguistic, racial, ethnic, religious backgrounds, and congenital or acquired disabilities.

JOB RESPONSIBILITIES:

• Review and ensure effective development and execution of personalized care plans that result in improved satisfaction & outcomes for all participants.
• Facilitate and complete the process of Interdisciplinary Team (IDT) meetings, Service Delivery Requests (SDR), and other meetings. This includes completing the attestations as needed. Support and collaborate with the Virtual IDT as needed.
• Serve as a manager on call during non-operational hours of the physical sites and was responsible for follow-ups, including follow-up documentation and initiating grievances on participants/caregivers behalf in a timely manner.
• Responsible for running necessary Clinical Delivery reports.
• Participates and represents the Community Health Nurse (CHN) in IDT meetings, when required.
• Balance and allocate staffing and related resources throughout the site and ensure adequate team assignments and coverage as a seamless operation.
• Responsible for ongoing communication with IDT and necessary parties involved to coordinate care consistent with the participants health care needs and goals to support in attaining and maintaining optimal health status.
• Collaborate with clinicians to review UAS and the UAS analyzer system to ensure the accuracy of their assessments.
• Ensure all incidents are investigated and addressed accordingly. Ensure Level 2 investigation and documentation are completed in a timely manner according to the CLHC regulation.
• Ensure documentation for participants is complete, and accurate, including and not limited to enrollment, disenrollment, electronic/paper medical record, and any other clinical notes.
• Review participants charts for quality and address any deficiencies.
• In collaboration with the Transitions in Care Team, provide care management services across sites and communicate with appropriate team members, facility, discharge planner, and home care coordinator when members are transitioned between care settings.
• Coordinates, facilitates, and arranges for long-term care services in nursing homes, rehab facilities, etc., as needed
• Monitor care management activities, services, and members responses to interventions to determine the effectiveness of the plan of care and the utilization of services and implements changes and adjustments to meet needs and goals.
• Ensure documentations are in accordance with CLHC standards and federal/state regulations
• Maintain up-to-date knowledge about current health-related issues, procedures, evidence-based clinical practices guidelines, medications, and impacting health and practice standards.
• Recommend and contribute to improvements in services, programs, policies, and procedures to ensure optimum care and services to members.
• Collaborate with Human Resources Department (HR) in conducting Interviews, coaching, and disciplinary action if needed. Assist in onboarding and professional development training of staff to ensure compliance with policies/procedures/regulations, as well as developing a continuous learning environment focused on growth and continued advancement. Ensures appropriate regulatory compliance is effective and being met at all federal and state levels.
• Evaluates the work performance and competency of direct reports. This includes ongoing informal feedback/counseling/support and completion of annual performance reviews.
• Ensures that direct reports conduct their duties according to applicable rules and regulations as well as the organizations policies and procedures
• Investigate and resolve employee grievances and complaints.
• Serve as the Director of Patient Services (DPS) for the LHCSA, as assigned.
• All other duties as assigned.

Weekly Hours: 37.5 Hours

Schedule: 8:30 AM - 5:00 PM

JOB QUALIFICATIONS:

Education:

• Degree from an NLN accredited nursing school (RN, BSN required or at least 5 years experience in health care setting).
• Successful completion of an accredited Nursing Program is required.
• A Baccalaureate degree is highly desired.
• Completed NYSED-approved infection control coursework.
• A minimum of 8.0 education contact hours may include contact hours of mandatory training requirements such as infection control coursework.
• Case Management Certification recommended within 2 years of the employment

Experience:

• Minimum of 2 years of administrative experience in a management capacity in a certified home health agency (CHHA), long-term home health care (LHCSA), acute care, medical-surgical, and/or critical care, nursing home experience, diagnostic & treatment clinic preferred.
• Customer Service experience is required.
• Managed long-term care insurance experience beneficial.
• Minimum of 1-year experience working with the elderly
• Supervisory experience is required.

License Registration:

• Current active and unrestricted license and registration in New York State required as a Registered Nurse.

Language:

Bilingual preferred