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Manager of Care Management

Seattle, WA



The Manager of Care Management is a full time position, responsible for assisting the Director of Medical Care Management in the day to day management of operational, clinical and functional support for the following programs:


Enhanced Concurrent Review - Medical Utilization Management, The Manager supervises staff in multiple locations including remote or telecommuter staff.. Responsibility for hiring, coaching and completion of performance evaluations. Assists with policy and procedures, accreditation and regulatory standards. Offers input and works with the appropriate departments to support
the development and launch of new and existing programs, reporting and/or technology; Works with our internal and external clients to deliver quality products and provide excellent customer service.


Education/License/Certification


Licensed RN with current, unrestricted license required
Bachelor's degree preferred in a health science


Experience


Two-three years clinical experience in care management or acute hospital discharge planning required.
Three years full-time direct clinical or critical care to patients in a medical/surgical setting.
5 years experience in Triage or Utilization Management or Case Management, and/or other managed care or cost management program.
At least 5 years Call Center Management experience preferred.
Experience with application of healthcare criteria systems and programs, e.g. Triage, InterQual, Milliman, CMS.
Must have previous experience with URAC and or NCQA accreditation process.


Knowledge/Skills


Ability to manage and coordinate programs, projects, resources, and staff across multiple company functions;
Strong administrative qualities to analyze goals, products, programs, and processes and make recommendations for changes;
Knowledge of all aspects of the following managed care products: utilization management, case management, disease management and triage;
Organizational and project management skills;
Experience working with clinical documentation programs designed for case management, disease management, utilization management and triage programs;
Strong computer skills and experience with Microsoft Office;
Strong communication, interpersonal and leadership skills.


Job Performance/Responsibilities


Coordinates and manages all Medical Utilization Management, Case Management, and Nurse Triage programs.
Assure job descriptions and staff roles/responsibilities are accurate and current
Responsible for supervision and oversight of staff
Supervise the interviewing and hiring of staff and supervisors for the above programs;
Assist in the licensing and accreditation process for all programs;
Assure that all regulatory and accreditation standards are implemented and met;
Assure that Policies & Procedures, Operational Guidelines, and process workflows are current meet quality accreditation and regulatory standards, and are communicated to and available for staff on the IntraNet;
Develop annual Workplan & Evaluation for each program in conjunction with the QI committee (includes goals, objectives, and planned new processes/enhancements) and communicates the Annual Workplan and previous year's Summary to Senior Management and staff;
Assist the Quality department in the development and evaluation of an annual QI plan for all programs and assures all indicators are met;
Participate in the Quality Committee and assists in related functions;
Analyze all programs to ensure effectiveness, quality, productivity, profitability and patient safety;
Coordinate all programs and work with other Health Integrated Departments and Committees, i.e. Quality Committee, Education, Account Management, etc;
Assist in new product development efforts and assures current products are being delivered as designed;
Assist the Director in plans for growth;
Provide input and direction to Information Services on systems issues and enhancements;
Offer input and assist with development of orientation, education and training programs
Assure delivery expectations of client contracts are being met;
Assist in the development of management reporting capabilities and works with supervisors to ensure they understand and use them to effectively manage the delivery of services; and provide required reports and special projects as needed.
Ensure clinical staff consult and seek advice from a licensed physician with expertise appropriate to the types of services being managed


Please direct all inquiries to David Mara at (804) 402-8088 or e-mail at dmara@nexushc.com. For more information about Nexus Healthcare go to www.nexushc.com

Doctors, nurses focus on caring for patients despite their losses

An interesting story on the grief that health care providers often cope with.

Access here

Diabetes Management

NIH Announces New Strategic Plan to Combat Diabetes

From the PharmaLive.com News Archive (March 18, 2011)

Multiple stakeholders tapped to develop roadmap for preventing, treating and finding a cure

A new strategic plan to guide diabetes-related research over the next decade was announced today by the National Institutes of Health. The plan, developed by a federal work group led by the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), identifies research opportunities with the greatest potential to benefit the millions of Americans who are living with or at risk for diabetes and its complications.

"By setting priorities and identifying the most compelling research opportunities, the strategic plan will guide NIH, other federal agencies and the investigative community in efforts to improve diabetes treatments and identify ways to keep more people healthy," said NIDDK Director Griffin P. Rodgers, M.D.

The plan, Advances and Emerging Opportunities in Diabetes Research: A Strategic Planning Report of the Diabetes Mellitus Interagency Coordinating Committee, focuses on 10 areas of diabetes research with the most promise. The goal is to accelerate discovery on several fronts, including:

-- the relationship between obesity and type 2 diabetes, and how both conditions may be affected by genetics and environment -- the autoimmune mechanisms at work in type 1 diabetes -- the biology of beta cells, which release insulin in the pancreas -- development of artificial pancreas technologies to improve management of blood sugar levels -- prevention of complications of diabetes that affect the heart, eyes, kidneys, nervous system and other organs -- reduction of the impact of diabetes on groups disproportionately affected by the disease, including the elderly and racial and ethnic minorities

Under the plan, NIH will continue to emphasize clinical research in humans, which already has led to highly effective methods for managing diabetes and preventing complications, Rodgers said.

The NIH strategy for fighting diabetes addresses type 1 and type 2 diabetes. Type 1 diabetes, which affects about 5 percent of individuals with diagnosed diabetes, is an autoimmune disease that most often develops during childhood. Type 2 diabetes accounts for 90 to 95 percent of diagnosed diabetes cases in the United States, and is strongly associated with overweight and obesity. In addition, the plan addresses gestational diabetes, a condition that some women develop during pregnancy, but which usually goes away after their child is born. Women who develop gestational diabetes during pregnancy are at increased risk for developing type 2 diabetes, and the child of that pregnancy may also be at increased risk for obesity and type 2 diabetes.

Today, about 1 in 10 adults in the United States has diabetes, according to the Centers for Disease Control and Prevention. About 1.9 million Americans aged 20 years or older were newly diagnosed with diabetes in 2010. In addition, an estimated 79 million American adults have pre-diabetes, a condition in which blood sugar levels are higher than normal but not high enough to be diagnosed as diabetes. By 2050, as many as 1 in 3 adults could be diagnosed with diabetes if current trends continue, according to the CDC. The projection assumes that recent increases in new cases of diabetes will continue and people with diabetes will also live longer, which adds to the total number of people with the disease.

Diabetes eventually damages nearly every organ system in the body. People with diabetes are at increased risk for blindness, kidney failure, and lower limb amputation. Overall, the risk for death among people with diabetes is about twice that of people of similar age without diabetes. In addition, it is a very expensive disease to manage. Total costs of diabetes, including medical care, disability, and premature death, reached an estimated $174 billion in 2007 in the United States.

The plan was developed by the Diabetes Mellitus Interagency Coordinating Committee (DMICC) (http://www2.niddk.nih.gov/AboutNIDDK/CommitteesAndWorkingGroups/DMICC/), a congressionally authorized workgroup chaired by the NIDDK. Established in 1974, the DMICC facilitates cooperation, communication, and collaboration on diabetes research across the federal government. Key elements of the report were identified by multiple public and private stakeholders, including representatives of DMICC member agencies, health advocacy groups and external scientists who are leaders in the diabetes research field. To ensure broad input, a draft of the strategic plan was also posted for public comment prior to publication. The strategic plan is available electronically at <http://diabetesplan.niddk.nih.gov/>. Printed copies can be requested from the National Diabetes Information Clearinghouse beginning April 1, 2011, at 1-800-860-8747 and by email at <ndic@info.niddk.nih.gov>. Single copies are free.

The NIDDK, a component of the National Institutes of Health (NIH), conducts and supports research on diabetes and other endocrine and metabolic diseases; digestive diseases, nutrition and obesity; and kidney, urologic and hematologic diseases. Spanning the full spectrum of medicine and afflicting people of all ages and ethnic groups, these diseases encompass some of the most common, severe and disabling conditions affecting Americans. For more information about the NIDDK and its programs, see <www.niddk.nih.gov>.

The National Institutes of Health (NIH) -- The Nation's Medical Research Agency -- includes 27 Institutes and Centers and is a component of the U.S. Department of Health and Human Services. It is the primary federal agency for conducting and supporting basic, clinical and translational medical research, and it investigates the causes, treatments, and cures for both common and rare diseases. For more information about NIH and its programs, visit <www.nih.gov>.

CONTACT: Rita Zeidner, 301-496-3583, NIDDKMedia@mail.nih.gov

Spring Managed Care Forum

Check out: upcoming Spring Managed Care Forum

Managed Care Forum

Welcome to our Blog

Welcome to the Blog of the American Academy of Case Management. All of our certified members, students and all health care professionals are invited to join our "blog" community. Please feel free to begin conversations related to the subjects of Case Management and Managed Health Care. We also welcome notices of events, seminars, new books, and any and all information relevant to professional Case Management practice. This blog is monitored by a moderator. Thank you for joining!

Sincerely,
Dominick L. Flarey, Ph.D, MBA, RN-BC, FACHE
Executive Director