Manager of Case Management

Manager of Case Management for Medicare Patients

Welcome Health is an advanced primary care organization dedicated to transforming care for older adults. Our model of care is steeped in the science of geriatric medicine. As a risk bearing organization, we contract primarily with Medicare Advantage plans to significantly improve access to and quality of care of members who are 65 years and older who are assigned to us by the health plan or enroll directly. Our care is provided in 3 settings : patient homes, clinics / facilities and virtually. We are hiring a Manager of Case Management to establish and oversee Welcome Health’s case management efforts. In addition to establishing our case management program, systems and processes, this position will manage case managers, community health and social workers who are instrumental in addressing social determinants of health and other barriers that threaten patient quality of life, health and wellbeing and increase risk of hospitalizations and healthcare costs.

Location :  Southern California, Hybrid Role (remote, in facilities and patient homes). We anticipate that approximately 80% of this role will be performed remotely.

Employment Type :  Full time, exempt

Here are the responsibilities and qualifications of this role :

Key Responsibilities :

• Establish Comprehensive Case Management Program that includes, the following dimensions :
• Case Management : Collaboration in the patient care process to assess, plan, facilitate, coordinate, monitor, and evaluate options and services to meet patients' health needs.
• Care Transition Support : Support for patients or their representatives regarding care, care transitions, and changes in health status. Implementation of a comprehensive clinical case management plan for each patient.
• Plan Evaluation and Revision : Obtaining input from providers, patients, and families as appropriate, and evaluation and revision of plans as needed.
• Care Coordination : Coordination and management of comprehensive care plans for Medicare patients, continuity of care across various healthcare settings; tracking and evaluation of patient outcomes and adjustment of care plans as necessary.
• Patient Education : Education of patients and their families about chronic disease management, medication adherence, and self-care techniques; promotion of preventive health measures and wellness programs.
• Treatment Plan Adherence : Monitoring of patient compliance with treatment plans and intervention as necessary to improve adherence.
• Hospital Readmission Reduction : Implementation of strategies to reduce hospital readmissions by closely monitoring patient conditions and providing timely interventions.
• Emergency Room Visit Reduction : Development and execution of plans to reduce unnecessary ER visits through proactive patient management and education.
• Quality Improvement : Participation in and improvement of quality improvement initiatives to enhance patient care and meet key performance indicators (e.g., HEDIS, CMS Star Ratings).
• Collaboration : Establishment and promotion of systems and culture for working collaboratively with primary care providers, specialists, other healthcare team members including case managers who work in our partnered Managed Services Organization (MSO) to ensure coordinated and efficient care delivery.
• Patient Treatment :  On occasion and within the bounds of state regulations and licensure requirements, direct delivery of nursing care.
• Documentation : Assurance of accurate and timely documentation of case management- related patient interactions, care plans, and outcomes in the electronic medical record (EMR) system.
• Patient Advocacy : Advocacy that ensures that patients' needs and preferences are respected and addressed.
• Variance Analysis and Reporting :  Development of systems and reports that analyze patient variances from the plan and compel that appropriate steps to resolve variances are taken; tracking and reporting of key performance indicators to assess program effectiveness; leading and participating in continuous improvement efforts.
• Admission and Concurrent Stay Reviews : Performance of admission and concurrent stay reviews on hospitalized patients.
• Discharge Planning : Development and implementation of discharge planning for patients in conjunction with hospital-based case managers.
• Telephonic and On-site Reviews : Performance of telephonic, fax, and / or on-site reviews with skilled nursing facilities, home health agencies, or other contracted service agencies to determine the need for continued care.
• Hire, Train and Manage a Team of Professionals
• Support or directly recruit, select, onboard and manage clinical staff.
• Draft, deliver and maintain training materials for Case Managers, Community Health Workers, Social Workers, and other roles as needed.
• Draft job descriptions, standard work, job aids and other collateral to support direct reports in the performance of their duties.
• Oversee the quality of work of direct reports.
• Foster a learning and feedback culture by providing in-services and coaching to team members.
• Demonstrate and advocate Welcome Health's vision, mission and values.

Qualifications :

Skills :

Benefits include :

Welcome Health provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state, or local laws.

Salary : $135,000 - $155,000