Care Team Manager

JOB SUMMARY 

The Care Team Manager is responsible for managing the PACE Interdisciplinary Team (IDT). The key responsibilities and skills of the position are management, coordination and facilitation of assigned interdisciplinary team, collaboration with all disciplines and departments, supervision and training of assigned IDT staff, facilitating and scheduling team meetings, the development of and implementation of participant care plans and all authorized interventions. 

ESSESNTIAL DUTIES AND RESPONSIBILITIES  

• Responsible for care provided by the interdisciplinary team (IDT) including assessments, care plan development, and implementation of all care plan interventions. 
• Facilitate the interdisciplinary team meetings; ensure communication of participant changes, collaborating on care planning decisions and coordination of 24-hour care delivery, ensure that the team’s processes and decision making meets regulatory and quality standards, and consistently align with the PACE model and organization’s core values.  
• Ensure all participant care plan interventions are implemented and documented, all specialist recommendations, diagnostic results, and hospital discharge instructions are reviewed, approved if appropriate, and followed up. 
• Provides management oversight to IDT members, providing guidance, feedback and support in their provision of participant care. 
• Actively communicate relevant issues to the team, ensure all team members are informed and up to date, participate in the development of the plan of care and monitor and articulate participant’s progress and decline.  
• Monitor IDT operations to ensure consistent compliance with established quality assurance standards. Audits documentation regularly and provides feedback to staff to ensure compliance with policies, procedures and regulations.  
• Addresses and ensures the IDT addresses all participant issues promptly and thoroughly to ensure optimal participant experience and clinical outcomes. 
• Reviews the high-risk participants daily and ensures the IDT closely monitors their status and intervenes as needed. 
• Functions in the Center Manager role on the IDT (per CMS regulations). 
• Fills the role of other IDT members according to competencies and qualifications. 
• Ensures close follow-up of institutionalized participants (acute care, nursing home, assisted living) to promote optimal clinical care and outcomes. Maintains communication with all facilities providing services to participants. Ensures documentation from these facilities for inclusion in the PACE medical record. 
• Review and discuss participant experience outcomes (hospitalizations, emergency care, home care, etc.) regularly with the IDT and administration to problem solve and plan for service improvements.  
• Recommend changes in service delivery and staffing as required by the development and growth of the agency. 
• Participate regularly in all quality assurance/quality improvement committees as part of the overall quality improvement program. 
• Ensure all activities and operations are performed in compliance with local, state, and federal contracts, regulations, laws, accreditation, protocol, licensing and certification requirements governing PACE operations. 
• Monitors operational compliance with OSHA regulations and agency policies and procedures. 
• Protect privacy and maintain confidentiality of all company procedures and information about employees, participants, clients or families. 
• Participate in continuing education classes and any required staff and training meetings. Maintain professional affiliations and any required certifications.
• Provide administrative on-call coverage on a rotation basis. 
• Ensure that participant’s medical record and demographic information is maintained and updated.  
• Perform related duties as required or requested. 

EXPERIENCE, EDUCATION AND CERTIFICATIONS  

• Minimum of 5 years working in a health care setting.
• 3 years in healthcare-related management position (preferably in a geriatric setting).   
• RN license preferred
• 1 year working with the elderly, if this is not present, training on working with a frail or elderly population will be provided upon hire.

PRE-EMPLOYMENT REQUIREMENTS  

• Must have reliable transportation, a valid driver's license, and the minimum state required liability auto insurance.    
• Be medically cleared for communicable diseases and have all immunizations up to date before engaging in direct participant contact.  
• Pass a comprehensive criminal background check that may include, but is not limited to, federal and state Medicare/Medicaid exclusion lists, criminal history, education verification, license verification, reference check, and drug screen.