Care Management Manager

About North Country Healthcare (NCH):

North Country Healthcare is a non-profit affiliation of four medical facilities, Androscoggin Valley Hospital, North Country Home Health & Hospice Agency, Upper Connecticut Valley Hospital, and Weeks Medical Center, located in the White Mountains Region of New Hampshire. NCH includes numerous physicians and medical providers at multiple locations. This leading comprehensive healthcare network which employs hundreds of highly-trained individuals delivers integrated patient care through three community hospitals, specialty clinics, and home health and hospice services. NCH remains committed to the health and well-being of the communities we serve. As a leader in a management position this role emphasizes advancing High-Reliability Organization (HRO) principles, embedding a culture of safety, accountability, and consistent high performance.

POSITION SUMMARY:

The NCH Care Management Manager will oversee the implementation, management, and continuous improvement of care management programs across the healthcare system. This position will work collaboratively with interdisciplinary teams to enhance patient care coordination, ensure high-quality care outcomes, streamline prior authorization and denials processes, and manage the system-wide care delivery process. The NCH Care Management Coordinator will provide strategic leadership and operational oversight for the care management team while promoting patient-centered care.

ESSENTIAL QUALIFICATIONS

Education:

• Bachelor’s degree in Nursing, Social Work, Healthcare Administration, or related field (required).
• Master’s degree preferred (MSW, MSN, or MHA).

Certification:

• Case Management Certification (CCM) or other relevant certifications (preferred).

Licensure:

• Active licensure as a Registered Nurse (RN), Social Worker (LCSW), or similar clinical designation (required).
• Association* accredited course in Basic Life Support (BLS) (for clinical staff), or Heartsaver CPR AED (for nonclinical staff), and renewal on a regular basis, with up to a three-month grace period after the expiration date.

Skills:

• Strong knowledge of care management principles, patient care coordination, and healthcare delivery systems.
• Experience with quality improvement, performance measurement, and reporting.
• Ability to lead and motivate multidisciplinary teams.
• Excellent communication, interpersonal, and problem-solving skills.
• Strong understanding of regulatory requirements and healthcare compliance standards.
• Proficiency with electronic health record (EHR) systems and other healthcare technology.

Work Experience:

• Minimum of 5 years of experience in care management, case management, or related healthcare field.
• At least 2 years of experience in a leadership role managing teams or programs.

Working Conditions:

• Full-time, dayshift
• Travel will be required across healthcare system facilities.
• Occasional evening or weekend work may be necessary based on patient and organizational needs.

Physical Requirements:

• Ability to sit, stand, and walk for extended periods.
• Occasional lifting of office equipment or patient care materials.

ESSENTIAL FUNCTIONS

1. Program Leadership:

• Lead and manage care management activities across multiple departments and settings, focusing primarily within inpatient care, but collaborating with outpatient care management teams
• Develop, implement, and monitor care management strategies to meet patient care goals, reduce hospital readmissions, improve patient outcomes, streamline prior authorization processes and decrease denials.
• Ensure alignment with organizational goals and clinical initiatives, such as patient safety, cost-effectiveness, and quality improvement.

1. Team Management & Support:

• Supervise and mentor care managers, case managers, and support staff.
• Conduct regular performance evaluations, provide feedback, and support the professional development of the care management team.
• Ensure that staff adhere to best practices, regulatory standards, and organizational policies related to patient care.

1. Patient Care Coordination:

• Oversee care coordination across the continuum of care to ensure patients receive appropriate services at the right time.
• Facilitate interdisciplinary collaboration with physicians, nurses, social workers, and other healthcare providers to develop personalized care plans.
• Act as a resource for the care management team and other healthcare providers in resolving complex patient care issues.

1. Quality Improvement & Compliance:

• Develop and implement strategies to improve the quality of care, patient satisfaction, and health outcomes.
• Ensure compliance with all regulatory requirements
• Collect, analyze, and report on care management metrics to demonstrate program effectiveness and identify areas for improvement.

1. Data Analysis & Reporting:

• Monitor and assess patient data, including utilization trends, hospital admissions, readmissions, and length of stay, to identify opportunities for intervention.
• Prepare and present reports on key performance indicators (KPIs) to senior leadership, stakeholders, and regulatory bodies.
• Utilize data to drive decision-making and process improvement in care management practices.

1. Patient Advocacy & Education:

• Serve as an advocate for patients, ensuring they receive the care and services they need, while promoting patient engagement and empowerment.
• Educate patients and their families about care plans, post-discharge instructions, and available community resources.
• Work to address social determinants of health that may impact patient outcomes.

1. Stakeholder Engagement & Communication:

• Build and maintain strong relationships with key stakeholders, including physicians, clinical teams, insurance providers, and community organizations.
• Communicate effectively with patients, families, and staff to ensure transparency and shared decision-making in care planning.

1. Operational Oversight:

• Contribute to budget development and resource allocation for care management services.
• Monitor operational efficiency and ensure that care management resources are used optimally.
• Assist in developing policies and procedures to streamline care management workflows.

NON-ESSENTIAL FUNCTIONS

1. Performs additional duties as assigned.
2. Adheres to facility Values, Service Excellence and Standards of Excellence.