Lead, RN Care Manager, TCM

What You’ll Do 

The Lead RN Care Manager (Lead RNCM) provides direct supervision of the RNCMs in the management of complex CKD and ESRD patients referred into the program. The Lead RNCM helps with training and chart auditing to ensure NCQA accreditation guidelines are met. This individual assists with efforts to develop, implement, evaluate, redesign, and modify Intensive Case Management practice standards and works closely with the ICM staff to safely, effectively and efficiently assist patients across and through the continuum of care. This position is a working lead role and will require active complex patient management. This position reports to Sr. Director, Transition of Care.  

The Day to Day 

• Supervises daily operations of the Intensive RN Case Management staff directed by the ICM Manager. Helps conduct employee performance reviews, monitors and mentors Intensive Case Management staff. 
• Coordinates with ICM staff to ensure safe/effective/efficient plans of care are implemented. Collaborates with ICM Manager to ensure effective processes and systems are established and maintained to meet goals. 
• Helps conduct chart audits per established policy to ensure achievement of NCQA accreditation. 
• Functions as a resource person for the complex care management processes pertaining to NCQA and CCM efforts. Participates in process improvement activities 
• Helps Coordinate daily flow of the ICM team (this includes overseeing PTO requests, assignment coverage, on-call coverage). Assists ICM Manger with mentoring and monitoring of documentation expectations in Care Management technology. 
• Performs comprehensive clinical assessments on complex patients and develops a care plan per NCQA guidelines with member-centric goals implemented, evaluated, and closed appropriately upon completion of goals. 
• Recognizes barriers to compliance and alterations in patient’s condition in a timely manner. 
• Plans and executes appropriate interventions, evaluates outcomes, and adjusts plan as needed. Maintains frequent patient contact as directed by ICM program guidelines. 
• Facilitates completion of patient goals through a multidisciplinary approach of collaboration with the Strive Care Team, external resources, and family members. 
• Collaborates with all levels of the clinical team to improve processes, communication, and team skills needed to provide the best care to our patients.  
• Monthly 5-10% of RN or NP charts will be audited to ensure quality care is being provided to our patients in accordance with our program description.  Performance management of clinical staff that are not meeting the quality audit expectations is a critical part of the clinical manager's role. 

Minimum Qualifications 

• Associate’s degree from accredited school of nursing. 
• 7+ years combined of related education, experience, or certification. 
• 2+ years experience working with NCQA CCM accreditation. 
• 2+ years complex care management experience or equivalent experience in healthcare environment. 
• Current Registered Nurse (RN) license in the state of practice required (position may require licensure in multiple states within a region). 
• Current BLS or CPR Certification required.   
• Efficient and reliable transportation, including an active driver’s license, allowing for the ability to travel across an assigned region to meet patient needs. Locations may include offices, clinics, and patient homes. 
• Provides in-person patient care which may include standing, sitting, walking, pushing, pulling, and lifting. 
• Internet Connectivity - Min Speeds: 3.8Mbps/3.0Mbps (up/down): Latency <60 ms. 

Preferred Qualifications 

• 1+ year of supervisory/management experience preferred.
• Certified Case Manager (CCM) certification preferred.
• Current knowledge of CKD/ESRD or Complex CM processes preferred.
• Managed/Value-Based Care and payor experience preferred. 

About You

• Able to use expert clinical practice, leadership skills, and critical thinking skills to efficiently coordinate and direct patient care among all health care providers while maximizing use of resources.
• Excellent communication and interpersonal skills. 
• The motivation and drive to work independently with minimal supervision to pursue continuous development of self and others are required. 
• Ability to foster principles of participative management by identifying/involving relevant individuals in program-related decisions is required. 
• Ability to apply creative and innovative approaches to help develop and maintain systems that achieve higher levels of multi-disciplinary team performance and desired patient outcomes is needed. 
• Strong analytical skills 

Annual Salary Range: $85,700.00-$104,000.00