Manages and supports the daily activities of the Care Management Team, including managing staff, scheduling, educating, monitoring, and evaluating the performance of assigned Team Members. Collaborates with leadership to develop and maintain policies and procedures and establish and monitor measurable care processes and metrics to achieve program performance goals. The team manages our Hypertension Program which will include disease management of a patient population with uncontrolled hypertension.

Major Responsibilities:

Provides direction to staff to ensure a high level of productivity; organizes schedules and coverage needs to ensure efficient operations. Serves as a resource to the care coordination/EPH team, monitors and reviews progress, accuracy and functioning of work, and provides guidance on more complex issues. Revises processes and metrics as needed to effectively assess outcomes.Establishes and maintains effective communication and working relationships with physicians, leadership, team members and payors in markets and sites supported by care management nursing services. Responds to concerns and provides problem resolution as appropriate.Establishes and monitors measurable care management processes and metrics to achieve quality and efficiency (cost and utilization) targets. Responsible for achieving EPH key results indicators.Collects, analyzes and reports data to measure and identify the effectiveness of care processes and variations from standards and expectations. Presents information to leadership; assists to establish measures, performance targets, and benchmarks to drive achievement of established goals.Identifies, develops and implements policies and procedures which enhance the ongoing care of patients served while remaining in compliance with regulatory requirements.Works with leadership to develop and implement new and enhanced existing services and programs.Develop, plan and evaluate ongoing education needs for specialty programs using evidence-based research to support Team Member's clinical practice.Monitor overall performance of Disease Management (Heart Failure, COPD, Diabetes, Hypertension), Pediatrics and Maternity specialty programs. Collaborates with multidisciplinary team to identify, manage and evaluate clinical outcomes.Reinforces the orientation program for new team members to develop the professionalism and competence of the team member.Maintains current applicable standards of care established by the profession, regulatory bodies, and governmental agencies to ensure case completion and timeliness of documentation. Acts as the primary liaison regarding operational issues with other departments (operational leadership, risk management, finance, managed care operations, and medical management).Performs human resources responsibilities for staff which include interviewing and selection of new employees, promotions, staff development, performance evaluations, compensation changes, resolution of employee concerns, corrective actions, terminations, and overall employee morale.Develops and recommends operating and capital budgets and controls expenditures within approved budget objectives.Responsible for understanding and adhering to the organization's Code of Ethical Conduct and for ensuring that personal actions, and the actions of employees supervised, comply with the policies, regulations and laws applicable to the organization's business.

Licensure, Registration, and/or Certification Required:

Registered Nurse license issued by the state in which the team member practices. Must become licensed in either Wisconsin or Illinois.

Education Required:

Bachelor's Degree in Nursing.

Experience Required:

Typically requires 3 years of experience in in managed care/case management and a minimum of 3 years in clinical nursing. Typically requires 1 year of supervisory experience in management of staff and budgets.Clinical experience with Hypertension a plusExperience in Health Equity a plusExperience with remote patient monitoring technology a plus

Knowledge, Skills & Abilities Required:

CM/Care Transitions certification within 2 years or advanced nursing degree/active enrollment in advanced degree program in lieu of certification.Critical thinking and problem solving to identify and implement new care delivery models.Proficiency in interpretation and representation of statistical data. Computer competency in running reports, files, data manipulation.Strong relationship and strategic partnering with various teams/executives to achieve shared objectives.Leadership and change management skills, to motivate and coordinate participation.Excellent written and interpersonal communication/presentation skills. Effective oral and written communication with all levels of employees.Experience working with diverse groups on a variety of clinical, care management, and quality related projects.Experience in transitional care principles.Experience in state, fed, payer/NCQA regulatory requirements.Skills in managing multiple conflicting and complex demands in geographically dispersed areas.Ability to work well within a team atmosphere while recognizing and meeting the individualized needs of customers and internal and external partners.Ability to manage multiple priorities in a dynamic work environment.Competent use of Microsoft Suite and Epic.

Physical Requirements and Working Conditions:

Exposed to normal office environment including usual hazards related to operating electrical equipment.Operates all equipment necessary to perform the job.Position requires travel and will be exposed to road and weather conditions.Functional speech and hearing to allow for effective communication of instructions and conversation over the telephone.

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This job description indicates the general nature and level of work expected of the incumbent. It is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities required of the incumbent. Incumbent may be required to perform other related duties.