Job Description

Job Description

Stamford Health, a well-established, award winning Healthcare System with multiple locations in CT has an opportunity for a Care Manager, Value Based Programs in Stamford, CT.

As a New Certified Great Place To Work Organization, Stamford Health Understands What It Takes To Attract Talent In Order To Improve Our Workforce And Support Our Mission, To That End We Offer

• Competitive salary
• Comprehensive, low-cost health insurance plans available day one
• Wellness programs
• Paid Time Off accruals
• Tax deferred annuity and (403b) pension plan
• Tuition reimbursement
• Free on-site parking

Job Summary

The Value Based Case Manager is responsible collaborating with the Exec. Director of Care Management & Director of Quality to create & implement strategic plans for value-based care management programs. This includes coordinating the care and instituting appropriate interventions for high-risk patients with complex care needs. Assesses plans and evaluates the outcomes of care in collaboration with the other members of the health care team. Guides and collaborates with health care team members within the continuum to ensure quality and cost-effective care is given within a timely manner and an appropriate, safe post-acute plan has been facilitated. Focus on readmissions and interventions to improve transitions of care. Analyzes insurance payor patient data and translates this into work plans for case management and care gap fulfillment. Develops reports on the management of defined patient populations and discusses population management with members of the Stamford care team and leadership.

Responsibilities

MAJOR ACCOUNTABILITIES / CRITICAL RESPONSIBILITIES:

• Works in conjunction with clinical teams and case management inside and outside of Stamford Health to coordinate complex patient care throughout the continuum of care. Works with the interdisciplinary team for identified populations with a focus on high risk, high cost and high utilizer patients.
• Collaborates with the Exec Director of Care Management & Director of Quality to create & implement strategic plans for value-based care management programs including the Anthem Connecticut State Employee program.
• Tracks & manages and reports on value-based care management program efficiency, cost & utilization measures.
• Participates in the development of budgets, health utilization measures, and financial measures.
• Tracks patient level performance & completes outreach to patients, practices & providers to facilitate higher quality & lower cost care for patients.
• Creates reports & presents regularly at meetings regarding program performance & outreach efforts to both internal and external audiences including senior leadership.
• Analyzes payor & internal data to target high risk, high cost and high utilizer patients of Stamford Health Medical Group and Stamford Hospital.
• Acts as a Super User for the organizational population health platforms & case management applications.
• Develops and participates in submission of reports to payers, regulatory agencies, foundations, and grant-making agencies.
• Collaborates with clinical teams, inpatient, and outpatient care management to develop plans for high risk and high-cost patients.
• Works with Quality Department to follow readmission data and trends.
• Participates in the Transitional Care Committee meetings (TCC).
• Provides ongoing assessment and case management of identified patient populations to ensure an accurate evaluation of patient needs, appropriate level of care, proper resource utilization, management of high-risk patients in post-acute setting. Develops goals for patient outcomes based on assessment within an appropriate time frame and documents in clinical records as needed.
• In coordination with practices and case management, maintains ongoing communication regarding patient care with physicians, referral sources, caregivers, and patients to facilitate, coordinate, and support transition of care. Communication is effective and clear while following identified population in post-acute setting.
• Independently initiates assessments of situations. Identifies and explores alternative care opportunities and chooses appropriate courses of action in areas within scope of practice.
• Acts as an advocate for individual’s health care needs. Identifies barriers and advocates for patient access to care. Identifies system problems within the acute care system as well as the community which are barriers to timely care.
• Incorporates Social Determinants of Health issues into the plan of care.
• Responsible for maintaining a professional relationship with referral sources and community resources and participating in local professional organizations and activities.
• May conduct visits in the field, home, skilled nursing facility, doctor’s office, etc. when needed to assess and/or evaluate patient’s needs or environment of care.
• Provides patients and families support and information about their current condition, diagnosis, and co-morbidities.
• Based on growth and development of the value-based program, develops and supervises an assistant or analyst role.
• Provides education and support to clinical staff regarding community resources, managed care issues, or payment/ payer issues.
• Demonstrates an ability to be flexible, organized, and functional under stressful situations. Utilizes critical thinking skills and sound judgment in priority setting and delegation.
• Practices autonomously, consistent with evidenced-based standards. Pursues personal and professional growth and development.
• Performs other related duties as assigned or requested in order to maintain a high level of service.

Qualifications/Requirements

QUALIFICATIONS

• Bachelors prepared Registered Nurse licensed in the state of Connecticut is required. Strong clinical experience in an acute care setting with additional experience in home care, long term care and case management is preferred. Professional certification in case management or clinical specialty is highly desirable. Experience in the area of value-based care programs, quality or Care Transitions is desirable. Another clinical licensure will also be considered when combined with strong relevant experience.
• If not certified, will obtain ACM or CCM certification within one year of hire.
• Strong analytical skills with the ability to interpret data, create & implement strategic plans based on cost, utilization, and other quality indicators.
• Strong organizational and communication skills are essential.
• Completes required department and organization training and education in a timely manner.
• Demonstrates professional work behavior by following Stamford Health Standards for Service Excellence
• Complies with departmental organizational policies and procedures and adheres to external agency requirements.

Skills & Abilitites

Strong leadership, interpersonal, strong problem solving, goal setting, and decision-making skills. Prior case management, utilization management or discharge planning experience preferred. Prior experience with transitional care management strongly preferred. Experience with value-based care programs and metrics required. Experience with multi-aged and multicultural populations. Ability to work autonomously and manage time effectively and to work within a multidisciplinary team structure and large physician base.

Knowledge of legal and regulatory issues and insurance and third-party reimbursement. Experience with medical cost containment, resource utilization. Strong computer skills.

Certificates, Licenses, Registrations

Professional certification in case management or clinical specialty is highly desirable. BSN needs to be registered in the state of Connecticut. Master’s degree preferred.

• We are committed to building an inclusive workplace that values diversity and inclusion and reflects the diversity of the community and patients we serve.

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