POSITION SUMMARY:

The Manager of Complex Care Management supervises care management activities across clinical sites that are part of a Boston Medical Center Health System Accountable Care Organization.

Boston Medical Center Health System and their affiliated partners include a mix of academic medical centers, community hospitals, and community health centers across Greater Boston, The North Shore, Western Mass, and Southern Mass. In partnership with Wellsense Health Plan, clinical sites are collectively sharing risk for Medicaid patients as part of the MassHealth initiative to transform healthcare via formation of Medicaid ACOs. In partnership with Wellsense, BMCHS is rapidly designing and implementing a number of medical management programs to manage utilization and total cost of care, specifically for patients with the highest levels of risk and healthcare utilization. There will be several Managers of Accountable Care Transformation and Care Management across the BMCHS network. Managers will report to a Director of Care Management.

The Manager directly oversees front-line care management (CM) staff working in medical management programs. These programs are embedded in primary care, and hospital-based settings in the Wellsense ACO networks. The manager will work in a hybrid work setting spending time at clinical sites, interacting directly with the CM teams, as well as the opportunity to work from home. Care Management teams are comprised of Nurses or Social Workers, and Community Wellness Advocates (CWAs). The Manager will oversee staff in these roles and will collaborate with multi-disciplinary team members including pharmacists, behavioral health professionals, and others.

The Manager will be responsible for building a high-performing care management team. He/she will recruit, hire, and onboard staff who are passionate about social justice, caring for vulnerable patients, and clinical excellence. Given that staff may be located in multiple sites across the Wellsense ACO partners, it will be critical for the managers to build a team culture and sense of community that overcomes geographic separation across team members. He/she will be responsible for continuous improvement of the care management process, as well as the continued growth and development of his/her team.

Position: Manager ACO RN Complex Care Management

Department: Population Health

Schedule: Full Time

ESSENTIAL DUTIES/RESPONSIBILITIES:

Culture Building

• Ensure professional network and culture of support, inclusion, and development across care management team

Operations Management:

• Develop, manage, and onboard Care Managers at ACO sites
• Contribute to building a recruitment and retention strategy to attract top care management talent across Massachusetts
• Serve as key point person interfacing with local site Administrative Directors and Medical Directors to ensure integration of care management teams into primary care practices and hospitals; design integration and onboarding plans for local ACO CM teams, maintain open lines of communication with local site leaders

Performance Management:

• Review performance data for overall program and individual care managers and make action plans for improvement
• Develop policies and systems to hold CM staff accountable for individual performance

Quality Improvement:

• Constantly review, assess, and adjust CM workflows to optimize CM impact on targeted program outcomes including ambulatory engagement, inpatient utilization, and throughput of patients on the CM panel
• Partner with other CM Managers across BACO to recommend changes to IT system, reporting, policies, and procedures to contribute to the constant evolution of the CM process.

Metrics: Outcomes on the following metrics across assigned BACO sites:

• Reduction in ED and inpatient visits
• Decreased total medical expense
• Increased engagement in ambulatory services
• Improved patient satisfaction
• Improved clinical outcomes
• Improved provider satisfaction
• Reduction in avoidable admissions

JOB REQUIREMENTS

EDUCATION:

• Bachelor's degree in Nursing required
• Master's degree in related field preferred

EXPERIENCE:

• Experience working with Medicaid populations, including Behavioral Health and Substance Use Disorder preferred
• A minimum of four years of clinical experience is required, with care management experience preferred
• A minimum of 2 years of management experience preferred
• Experience working in the Primary Care setting preferred

KNOWLEDGE & SKILLS:

• Excellent interpersonal skills and ability to work collaboratively
• Management skills, including ability to prioritize set goals for team members
• Excellent written and verbal communication
• Ability to work with diverse, safety-net population
• Skilled at coaching Care Managers in care management skills and competencies, including clinical decision-making, patient engagement, etc.
• Creative problem solver
• Ability to adapt to changes in healthcare delivery at local and systems level
• Extensive knowledge of healthcare systems and community resources
• Ability to leverage systems and resources for improved patient outcomes
• Strong organizational and time management skills
• Ability to analyze performance data to identify performance opportunities and adjust and innovate models of care
• Additional Job Description

Hybrid position which allows work-from-home, and requires community-based work

This role will be embedded in one of the geographic regions served, and candidate preference will be considered: North Shore, Greater Boston, South Shore, South Coast, and Western Mass.
Req id: 29861