Case Manager

The University of Maryland Medical System (UMMS) is an academic private health system, focused on delivering compassionate, high quality care and putting discovery and innovation into practice at the bedside. Partnering with the University of Maryland School of Medicine, University of Maryland School of Nursing and University of Maryland, Baltimore who educate the state's future health care professionals, UMMS is an integrated network of care, delivering 25 percent of all hospital care in urban, suburban and rural communities across the state of Maryland. UMMS puts academic medicine within reach through primary and specialty care delivered at 11 hospitals, including the flagship University of Maryland Medical Center, the System's anchor institution in downtown Baltimore, as well as through a network of University of Maryland Urgent Care centers and more than 150 other locations in 13 counties. For more information, visit www.umms.org.

General Summary

We are seeking an experienced and detail-oriented Population Health Nurse to support our efforts in optimizing health outcomes, reducing costs, and enhancing patient experiences. You will design and implement strategies that align with NCQA population health management requirements and value-based care principles, supporting diverse patient populations across the care continuum.

Key Responsibilities

The following are key tasks that reflect the nature of this role, but additional responsibilities may apply:

• Apply NCQA population health management standards and evidence-based guidelines to assess patient needs, outcomes, and program effectiveness.
• Track and analyze data, including inpatient admissions, emergency department visits, readmissions, and high-cost utilizations, focusing on patients tied to value-based contracts.
• Develop and execute strategies for care management and chronic disease prevention for populations managed within value-based care frameworks.
• Identify at-risk patients and initiate tailored outreach or coordination of care interventions.
• Collaborate with primary care physicians and multidisciplinary teams to align care plans with patient-specific goals and NCQA best practices.
• Advocate, educate, and coach patients and families regarding care plans, health management tools, and community resources to promote self-care and engagement.
• Enhance the organization’s capacity for value-based care reporting, ensuring compliance with healthcare quality standards and payer contracts.
• Lead or contribute to the development of workflows and programs addressing gaps in care and population health metrics.
• Provide mentoring and supervision within a dedicated care team model, including delegating care management for routine and lower-risk populations.
• Assist in preparing for and maintaining compliance with NCQA accreditation and other state and federal healthcare regulations.
• Participate in performance improvement initiatives and share outcomes with leadership for program optimization.

Education and Experience

• Licensure as a Registered Nurse in the state of Maryland, or eligible to practice due to Compact state agreements outlined through the MD Board of Nursing, is required; BSN preferred.
• . 3 to 5 years of care coordination experience and/or experience working in an outpatient ambulatory setting
•  Experience with educating patients and patient goal setting (essential)
• Case Management Certification (preferred)
•  Experience in a manage care information environment (preferred)
•  Preferred experience would include knowledge of quality improvement processes (LEAN or PDSA); practice re-design work such as patient centered medical home and Joint Commission and National Committee for Quality Assurance (NCQA) accreditations.

Knowledge, Skills and Abilities

• Knowledge and experience with managing and overseeing the comprehensive assessment, planning, implementation and overall evaluation of individual patient needs
•  Proficient analytical, organization, and problem-solving skills to identify opportunities, to implement efficient work processes as it relates to case management
• Proficient documentation skills to maintain client records
• Ability to work effectively in a stressful work environment and handle confidential issues with integrity and discretion
• Critical thinking skills to analyze and solve problems
• Strong problem management strategies and issue resolution skills
• Excellent interpersonal, verbal, and written communication skills
• Strong organization skills, detail oriented, and knowledgeable
• Ability to work independently and effectively in a fast pace environment.
•  Ability to work productively in a stressful environment and effectively handle multiple projects and changing priorities.
• Ability to effectively present information and respond to questions from families, members, providers, and clients, as well as the ability to relate effectively to upper management
• Ability to work independently, handle multiple assignments, establish priorities, and demonstrate high level time management skills
• Understands benefit/payer systems and reimbursement structures for patients.
• Strong clinical knowledge of broad range of medical practice settings and healthcare delivery systems
• Thorough and solid knowledge of health care and managed care delivery systems. This includes standards of medical practice, insurance benefits structure, and the utilization and case management process.
• Knowledge of state and federal laws and resources
• Proficiency in Microsoft Office including Outlook, Word, Excel and PowerPoint; knowledge of or the ability to learn care management/EMRsoftware (e.g., Epic) and other software in order to perform job duties

All your information will be kept confidential according to EEO guidelines.

Compensation:
Pay Range: $35.08-$52.64
Other Compensation (if applicable): None
Review the 2024-2025 UMMS Benefits Guide