CLINICAL LEADER - Outpatient Care Management

Position Summary:

In direct delivery of patient care, and under the supervision of the VP of Accountable Care Operations & Population Health Strategy the Clinical Lead is a collaborative member of the Care Management Team.  In addition, the clinical lead oversees all care managers and related processes, policies, and will work collaboratively with the primary care teams to care for patients across the continuum. The clinical lead will establish good working relations with members of the outside medical and civic community in order to advocate for patients.

POSITION RESPONSIBILITIES: 

Responsible for day-to-day referrals, intake, oversight and prioritization of work for the care management team. Oversee and take lead on all high complexity cases including, but not limited to: Risk involvement, APS, DHHS, PP505. Responsible for time off approval, annual evaluations of care management staff, ensuring nursing coverage is maintained and scheduling. Ensure continuing education, certifications, BLS, and licensure are maintained for all employees. Assist with onboarding of new providers and service lines within practices, assist with training/education as needed, provide support and act as resource for complex and high-risk patients.

Position Specific Competencies:

• Assist with onboarding of new providers and service lines within practices, assist with training/education as needed, provide support
• Oversee and take lead on all high complexity cases including, but not limited to: Risk involvement, APS, DHHS, PP505.
• Oversee all care managers and related processes and policies and will work collaboratively with the primary care team to care for patients across the continuum. 
• Responsible for day-to-day referrals, intake, oversight and prioritization of work for the care management team.    
• Responsible for time off approval, ensuring nursing coverage is maintained and scheduling. Ensure continuing education, certifications, BLS, payroll, and licensure are maintained for all employees.     
• Establish good working relations with members of the outside medical and civic community in order to advocate for patients, including serving as the care management subject matter expert for our ACO, Community Care Partnership of Maine.
• Provide oversight for Maine Care Health Home Portal and ensure participation in required forums, serve as primary contact for the Behavioral Health Homes. 
• Assist with weekly utilization meetings within organization home health, and with community partners, and Maine Care ED pilot, PCHC, and internal meetings within Covenant
• Support grant requests, and serve as a resource for EMR related changes, upgrades, and implementation impacting care managers.
• Responsible for running reports related to utilization for care management and primary care practices on a daily and weekly basis for high-risk patients, high-cost patients, patients utilizing the emergency room, and hospital.
• The manager of care management will also be responsible for onboarding any new team members, and for overseeing the quality outreach medical assistant and will assist with quality reports and gaps in care for primary care practices.
• Assist with coordination of placement to transitional care bed at Hope House
• Locates emergency devices (i.e. oxygen and gas shut off valves, fire alarms, fire evacuation doors) and can verbalize role during emergency situations (i.e. code red, code blue, code steel, etc.).
• Maintain current BLS. Failure to maintain current BLS will result in inability to work until proof of re-certification is obtained.  
• Demonstrates competence in clinical practice, takes responsibility for professional growth.
• Schedules patients in the office to set patient goals and work on meeting them, providing education and support
• Documents nursing care (including patient education) consistently within charting guidelines and provides necessary documentation for reimbursement purposes.
• Reviews plan of care and updates per policy, prioritizes patient care effectively, and communicates with community agencies to coordinate services.
• Screens each patient for risk of re-admission and poor outcome using HIN Analytics and provides interventions to reduce patient risk.
• Communicates to patients’ PCP, patient needs, and concerns regarding plan of care.
• Performs other duties as assigned.
   

Qualifications

Education - Four-year college (Bachelor’s Degree) Required

Experience - 3 to 5 years of previous experience

License - State of Maine RN License

Cerrtifications - BLS

Covenant Health Mission Statement

We are a Catholic health ministry, providing healing and care for the whole person, in service to all in our communities.

Our Core Values:

•Compassion

We show respect, caring and sensitivity towards all, honoring the dignity of each person, especially the poor, vulnerable and suffering.

•Integrity

We promote justice and ethical behavior, and responsibly steward our human, financial and environmental resources.

•Collaboration

We work in partnership, dialogue and shared purpose to create healthy communities.

•Excellence

We deliver all services with the highest level of quality, while seeking creative innovation.

Applicants, employees and former employees are protected from employment discrimination based on race, color, religion, sex (including pregnancy, sexual orientation, or gender identity), national origin, age (40 or older), disability, and genetic information (including family medical history).