Manager, Social Support Complex Care

We’re unique.  You should be, too.

We’re changing lives every day.  For both our patients and our team members. Are you innovative and entrepreneurial minded? Is your work ethic and ambition off the charts?  Do you inspire others with your kindness and joy?

We’re different than most primary care providers. We’re rapidly expanding and we need great people to join our team.

The Manager, Social Support, Complex Care is a regional leadership position, accountable for the direction, leadership and support of our Social Complex Care Coordinators, Social Support Supervisors, and Social Support Managers, and all members of the Social Support team in delivering the day-to-day programmatic acute care strategy. These teams are dedicated to managing our complex care patients in meeting their social and/or behavioral health needs and ensuring their care in all environments is appropriate. This role, in collaboration with the PCP, center staff, and other members of the Complex Care team, provides program management for complex patients to ensure the patient’s progression through the continuum of care in a manner that achieves the desired clinical outcomes and effective resource management. This role also promotes consistent application of effective processes and social service accountability. More specifically, the incumbent is responsible for their team’s assigned patient case load. Their role is to proactively manage their assigned patients to prevent unnecessary hospital arrivals. In addition, they will be measured by re-admissions related to social needs of the subset of their patients. The Manager, Social Support, Complex Care, works closely with market clinical and operational leadership to support the ongoing improvement of social support operations. The success of this role is determined by the team’s impact that social needs management has on patients with complex social needs on preventing unnecessary hospital arrivals.

This role may directly manage a regional team that will include multiple areas, social support staff for the programs. As a member of the Complex Care Team, this role is responsible for high-value care across multiple regions, to serve as coach, mentor/trainer to all members of social support complex team, giving guidance in best practices, troubleshooting to optimize the value of care in hospital and community setting.

ESSENTIAL JOB DUTIES/RESPONSIBILITIES:

• Manages a team Social Workers, Licensed Social Workers, Social Support Coordinators, and Behavioral Health Coordinators.
• Actively involved in the full employment cycle of direct reports, including but not limited to participation in the recruitment process, annual performance appraisals, day-to-day oversight of staffing/scheduling needs, problem solving, exit interviews and termination/counseling decisions.
• Provides structure and assures consistent execution of the Social Support Process strategy and execution plan to reach yearly outcomes. Plays a key role in the Case Management Process (CMP), a collaborative model including patients, nurses, social workers, PCPs, specialists, other providers/practitioners and caregivers. Coordinates care with PCPs, Specialists and ancillary teams across the market.
• Advocates for and assists Intensive Community Managers, Post Acute Manager, Acute Care Manager, and all members of the Complex Team with ensuring patients achieve optimal health, access to care and appropriate utilization of resources.
• Consults with, encourages and influences physicians, specialists, and other providers to refer patients to complex social support management for assessment, planning, implementation, coordination, monitoring and evaluation to develop an individualized care plan prior to hospitalization which can result in decreased admissions and hospital sick days. Aids in identifying areas of opportunities at the PCP, center, and market level.
• Serves as the Social and/or Behavioral Health “expert” to support Social Support team members, Complex Care team, and center staff needs for market specific education.
• Facilitates medication reconciliation and adherence education; disease education and coaching; advance directive/end of life discussions and referral/authorization management with Social Support team members as needed.
• Educates and supports Social Complex Managers and Social/BH Complex Coordinators at appropriate and repeated intervals, assesses and reassesses the patient’s progress utilizing telephone and other technologies and resources. Depending on the progress, urges appropriate interventions to obtain optimal outcome.
• Monitors and manages social/BH and financial coordination of treatment plan of assigned patients to ensure timely, cost-effective, individualized service delivery to prevent unnecessary hospital arrivals, ensure patients are on their appropriate medication, and receive appropriate coordinated specialty care.
• Provides active Social Complex Manager/Coordinator duties to a small caseload based on regional needs. Provides support for catastrophic cases within the clinical support group.
• Assists with development and implementation of case management policies, processes, and standard operating procedures (SOPs) as appropriate.
• Precepts new Social Complex Managers and Social/BH Complex Coordinators.
• Assists with quality audits and data analyses to identify opportunities for improvement.
• Identifies problems or any dissatisfaction experienced by patients or referring source and works to resolve them to a high degree of service excellence. 
• Formulates, implements and evaluates educational strategies for staff, providing best outcomes for our patients and family members.
• Facilitates inter-disciplinary rounds in conjunction with market, regional, and home office physicians and leaders for discussion of complex needs and follows up on action items.
• Monitors, reports out, and addresses areas of opportunities progress towards goals, KPIs, and daily actions of regional team.
• Identifies and shares best practices to advance efficiency and performance.
• Assists with workflow efficiency improvement for clinical and operational practices.
• Works with Complex Care COE for development and implementation of best practices.
• Manages resources within established budget parameters, while actively participating in identification and implementation of cost saving strategies
• Performs other duties as assigned and modified at manager’s discretion.

KNOWLEDGE, SKILLS AND ABILITIES:

• Strong business acumen and experience in data analytics
• Excellent verbal and written communication skills to effectively connect with diverse populations including physicians, employees, patients and their families; comfortable giving group presentations
• Teaching abilities to conduct educational programs for PCP’s, Chen Med staff, and tier one hospital staff clearly and concisely
• Knowledge of care delivery capabilities along the continuum of care
• Superb interpersonal and critical thinking skills to work productively with all levels of organization personnel and to supervise the activities of a group of employees
• Resourcefulness to identify prompt and sustainable solutions to barriers in care delivery
• Leadership skills to direct others toward objectives that contribute to the success of the business unit. Ability to supervise and train employees, to include organizing, prioritizing, and scheduling work assignments
• Ability to cope with stressful situations, manage multiple and sometimes conflicting priorities simultaneously
• Flexibility with schedule, including off-shifts, weekends and holidays to meet the needs of patients, families or staff
• Fiscal skills to monitor and control costs and revenue
• Familiarity with professional and technical emerging knowledge
• Excellent knowledge of case management principles, healthcare management and reimbursement
• Excellent organizational and time management skills
• Proficient in Microsoft Office Suite products including Excel, Word, PowerPoint and Outlook, plus a variety of other word-processing, spreadsheet, database, e-mail and presentation software
• Ability and willingness to travel locally, regionally, and nationwide up to 30% of the time
• Spoken and written fluency in English, bilingual preferred
• This job requires use and exercise of independent judgment

EDUCATION AND EXPERIENCE CRITERIA:

• A valid, active Registered Nurse (RN) license in State of employment OR Bachelor’s degree in Social Work required
• Additionally, one of the following degree conditions is preferred:
  • Bachelor’s Degree in Nursing (BSN); OR
  • Associate degree in Nursing (ADN) with 2 years’ home health, case management or discharge planning work experience; OR
  • Bachelor’s degree in a health-related discipline
• Compact license required if available in state
• A minimum of two (2) years’ work experience in social work, case management, and/or discharge planning experience required
• State Licensure at a Master’s Level is preferred but may be required (dependent on state)
• If applicable, incumbent must be compliant with the mandatory laws of state licensure at the Master’s level
• A minimum of 5 years’ clinical work experience preferred
  • Experience in Clinical/Social/Behavioral Health Management with a minimum of 2 years’ utilization review and/or case management, home health and/or discharge planning experience highly desired
• Basic Life Support (BLS) certification from the American Heart Association (AMA) or American Red Cross required w/in first 90 days of employment
• This position requires possession and maintenance of a current, valid Driver’s License
• Case Management Certification through the Commission for Case Manager Certification (CCMC) or the American Association of Managed Care Nurses (AAMCN) preferred
• Hospital, healthcare setting experience is preferred
• Experience with psychological aspects of care desired
• Leadership experience in a healthcare setting highly desired (lead nurse, charge nurse, nursing supervisor, etc.)

PAY RANGE:

$91,165 - $130,235 Salary

The posted pay range represents the base hourly rate or base annual full-time salary for this position. Final compensation will depend on a variety of factors including but not limited to experience, education, geographic location, and other relevant factors. This position may also be eligible for a bonuses or commissions.

EMPLOYEE BENEFITS

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We’re ChenMed and we’re transforming healthcare for seniors and changing America’s healthcare for the better.  Family-owned and physician-led, our unique approach allows us to improve the health and well-being of the populations we serve. We’re growing rapidly as we seek to rescue more and more seniors from inadequate health care. 

ChenMed is changing lives for the people we serve and the people we hire.  With great compensation, comprehensive benefits, career development and advancement opportunities and so much more, our employees enjoy great work-life balance and opportunities to grow.  Join our team who make a difference in people’s lives every single day.

Current employees, if you want to apply to our internal career site, please click HERE

Current Contingent Worker please see job aid HERE to apply

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