The Manager of Care Coordination is responsible for overseeing the day-to-day operations of programs provided by the Care Coordination department.This role provides expertise and leadership to interdisciplinary teams across the Beebe continuum of care to optimize patient care and experience and achieve organizational goals.The Manager of Care Coordination is responsible for overseeing the Delmarva Post-Acute Care Network and the interface of Beebe Healthcare¿s Continuum of Care to the Post-Acute Care Network. The Manager of Care Coordination is a part of Beebe Healthcare¿s Continuum of Care leadership team.
This role reports directly to the Chief Population Health Officer.
Bachelor's degree in nursing required; MSN preferred.
5+ years of healthcare leadership experience
Cross continuum nursing experience preferred
BLS Healthcare certification
Strong communication and interpersonal skills required with internal and external stakeholders
Develop, implementation and oversight of care coordination programs to meet the needs of targeted patient populations and organizational goals.
Oversight and collaboration with Population Health Advanced Practice Providers to provide clinical oversight of Care Coordination, Transition of Care, and Chronic Care Management programs
Collaborate with The Medical Group and inpatient leadership to develop and implement a care coordination program
Extensive focus on high risk and complex care patients, leading a team of care coordinators in managing the Social Determinants of Health, care gap closure, and health coaching for high risk and high-cost populations.
Collaborates in care coordination for patients in value-based care contracts such as, Medicare Shared Savings Program ACOS, Medicare Advantage Plans, and Commercial Risk contracts. Accountable Care Organization - Accountable for ensuring CMS defined requirements for ACO participation are understood and effectively communicated to the appropriate constituents.
Plans and partners in interventions to assist practices in achieving optimal STARS performance, Annual Wellness Visits, and Transitions of Care.
Manage the daily operations of Transitional Care Management (TCM) calls.
Collaborate with Director of Risk Management & Director of Discharge Planning to identify high risk patients ensure a plan of care is in place for patients with high-risk incidental radiology test result findings.
Collaborate with the Medical Director of Pulmonary Services and Director of Respiratory Therapy Services to lead the COPD Governing Council and COPD patient care improvements.
Create reports and performs data analysis for care improvements.
Participate in key organizational meetings providing subject matter expertise to assist in achieving organizational goals.
Conduct regular meetings with the skilled nursing facilities (SNF) of the Delmarva Post-Acute Care Network to promote alignment between the acute and post-acute spectrum of the continuum of care.
Collaborate with Post-Acute Care leadership to implement bidirectional care improvements.
Performs chart reviews for the purpose of identifying opportunities to reduce SNF readmissions.
Review and manages payroll for Care Coordination team
Collaborate with other Population Health leadership to create departmental budgets.
Provide team member annual evaluations
Provides coaching, counseling, and disciplinary action to direct reports as needed.
Conduct monthly team meeting and weekly team huddles
Conduct monthly team member roundings.
Motivate by recognizing, promoting, and reinforcing positive behavior and exemplary performance
Education: Essential: * RN Diploma/RN Graduate Program
Beebe Healthcare serves the Sussex County community with a medical center located in beautiful, historic Lewes, Delaware, and convenient outpatient locations throughout the county. Founded in 1916 by two physician brothers, Drs. James Beebe and Richard C. Beebe, the medical center in Lewes is a 210-licensed-bed, not-for-profit seaside community hospital. Beebe's specialized service lines include cardiac and vascular, surgical services, oncology, women's health, and orthopaedic services. Beebe offers an array of inpatient, outpatient, emergency, and diagnostic services.
Beebe's five satellite campuses offer imaging, physical rehabilitation, and lab services, as well as walk-in care centers. In addition, Beebe offers Wound Healing & Hyperbaric Medicine and Diabetes Management & Medical Nutrition Therapy.
With a mission to serve the community, Beebe also offers many free screenings and outreach programs through its Population Health Department; and advanced medical care for those who are recuperating at home through Beebe Home Care Services.
Beebe is also training the next generation of nurses through the Margaret H. Rollins School of Nursing, located behind the Medical Cente...r in Lewes.
Beebe's Medical Staff has grown tremendously since the early 1990s. Employed physicians through Beebe Medical Group and our affiliated physicians on Beebe's Medical Staff now serve patients from Milford to Millville in specialties including cardiac surgery, dermatology, endocrinology, family practice, gastroenterology, general surgery, internal medicine, pediatric neurology, and surgical oncology.
Beebe is proud to offer quality care, close to home for the residents and visitors of Sussex County.