Operations Manager of Care Management and Social Services

Primary Function

• The manager of Care Management and Social Services plays a critical role in daily operations of the department ensuring that scheduling processes are conducted in a manner that is consistent with sound business practice, maintain staff morale, satisfies contractual obligations and provides leadership and integration between finance department and social services department
  
  

Education And Experience

Business Degree preferred. Must have five to seven years’ experience in the Health Care Industry delivering high quality, demand driven programs, managing system-wide teams and data management. Demonstrate leadership with the ability to plan strategically. Must have excellent communication and interpersonal skills and be proficient in the English language.

• Application of Knowledge and Skill
  
  

Operations Management

• Maintains appropriate Social Services Department scheduling for inpatient units and PHP.
• Manage department schedule and ensure practices of awarding shift and time off is in keeping with collective bargaining process/contract
• Assists in the recruitment and selection and administrative supervision of social services staff
• Responsible for the development of training schedules for new staff that reflect the needs of the department and hospital
• Oversee and approve payroll, monitoring code occurrences, trends and report variances to Director ((sick calls, tardiness, no punches)
• Provides direct support to the UR positions, administrative staff and reimbursement, address concerns and conduct annual performance evaluations.
• Collaborates with line staff to ensure that staffing needs are accommodated when they are in line with the needs of the hospital
• Serves as a resource for complex scheduling and interpersonal issues that cannot be solved at the scheduler/payroll specialist level
  
  

Utilization Review and Utilization Management

• Provides leadership and integration between finance department and social services department
• Daily operations related to UR and UM
• Represent department in revenue cycle
• Provide consultation to other hospital areas regarding UR and UM and assist with UR management and revenue cycle needs for new hospital programming
• Ensure compliance with CMS, Medicare Important Message process within the department
• Responsible for payer benefit changes and educating social service clinicians and other appropriate staff on changes and new regulations
• Monitors and interprets regulatory changes related to utilization review and advises appropriate staff including revenue cycle
• Identify staff development and training needs related to UR and UM and ensure training is obtained
• Attend quarterly and/or monthly meetings with payers relating to quality measures and reimbursement.
• Communicate and collaborate with Patient Financial Services and other departments in hospital to ensure effective utilization review activity
• Profiles at risk cases to leadership for financial liability
• Compiling data and reviewing reports related to utilization review, appeals, at risk cases, UR dashboard and present to UR committee and other hospital leadership as n Complying and analyzing reports for UR and department productivity
  
  

II. Planning, Productivity and Decision Making

• Effectively prioritize own work in order to complete job responsibilities. Displays ability to adjust priorities based upon understanding of policies and procedures.
• Completes job responsibilities within required timeframe, according to established schedules or workflow requirements.
• Displays an ability to evaluate areas in need of improvement and provides input in order to improve current methods, services, programs or technology.
• Reviews and assesses information before making decisions and solving problems.
• Uses proper judgment and knowledge of established practices and procedures when addressing problems or issues.
  
  

IV. Teamwork

• Demonstrates an ability to work well with employees at all levels across Care New England.
• Contributes information, ideas and opinions in a group setting.
• Volunteers for team assignments or group problem solving
• Represents own ideas and solutions while acknowledging and/or accepting ideas and solutions of others.
  
  

V. Communications

• Written communication is clear, concise and professional as well as appropriate to the recipient.
• Verbal communication is clear, professional in tone, non-threatening and appropriate to the recipient.
• Identifies which type of communication is appropriate under different circumstances.
• Is attentive, actively listens and can accurately relay information.
  
  

VI. Personal Development

• Maintains professional growth and development.
• Participates in task forces and committees.
• Attends seminars, workshops and conferences as appropriate.
  
  

VII. Supervision

• Provides input and assistance in the training and development of employees.
• Manages administrative assistant position and reimbursement coordinator position
  
  

VIII. Department Standards

• Dependability:
  
  

Effectively plans and schedules time off

• Attendance:
  
  

Number of days absent due to unscheduled PTO: _____

Number of days tardy: _____

• Appearance:
  
  

Exhibits acceptable personal neatness and hygiene.

Dresses acceptably

IX. CNE-Wide Standards

Care New England Values

• Accountability
• Set clear expectations and provide timely feedback and follow-through
• Do what you say you're going to do- and be fair about it
• Take ownership of your responsibilities
• Caring
• Acknowledge and respond to the needs and challenges of every person
• Create an environment that encourages respect and appreciation
• Offer support, information and hope
• Teamwork
• Listen and value each person's voice
• Ask "how can I help?”
• Support the work of each team and each team member
  

Care New England Health System (CNE) and its member institutions, Butler Hospital, Women & Infants Hospital, Kent Hospital, VNA of Care New England, Integra, The Providence Center, and Care New England Medical Group, and our Wellness Center, are trusted organizations fueling the latest advances in medical research, attracting top specialty-trained doctors, and honing renowned services and innovative programs to engage in the important discussions people need to have about their health.

EEOC Statement: Care New England is an equal opportunity employer. All applicants will be considered for employment without attention to race, color, religion, sex, sexual orientation, gender identity, national origin, veteran or disability status

Ethics Statement: Employee conducts himself/herself consistent with the ethical standards of the organization including, but not limited to hospital policy, mission, vision, and values.

Americans with Disability Act Statement: External and internal applicants, as well as position incumbents who become disabled must be able to perform the essential job-specific functions either unaided or with the assistance of a reasonable accommodation, to be determined by the organization on a case-by-case basis.