Manager, Ambulatory Case Management and Social Work

Job Description SummaryUnder the direction of the Ambulatory Case Management Officer (ACMO), the Manager of Ambulatory Case Management & Social Work provides operational leadership and strategic direction for South Shore Health's ambulatory case management and social work functions. This role oversees day-to-day operations, resource allocation, and team prioritization across five core areas: CMS TEAM episodic bundle coordination and preferred SNF network management; ambulatory case management and social work support for SSMC and other SSH practices; Workers' Compensation case management oversight; relationship management with delegated case management organizations under VBC and risk contracts; and general day-to-day team supervision, mentoring, and performance management. The Manager supervises seven to eight direct and dotted-line reports and promotes individualized, goal-directed case management aligned with departmental and health system policies.Job DescriptionESSENTIAL FUNCTIONS1 - Oversees CMS TEAM Program case management and preferred SNF network performance.a - Provides operational oversight of case management activities supporting the CMS TEAM episodic bundle program, including pre-operative outreach, post-discharge follow-up, and ED return monitoring for LEJR and hip fracture surgical episodes.b - Manages preferred SNF partner relationships, including coordination of embedded CM specialist rounding, SNF pathway compliance monitoring, and performance tracking against length-of-stay targets and SNF-to-ED transfer rates.c - Partners with the ACMO and surgical service line leaders to identify TEAM bundle performance gaps and develop proactive case management interventions.d - Monitors SNF-associated quality indicators including HAI prevention, Foley catheter protocols, antibiotic stewardship, and C-diff detection to reduce downstream impacts on VBP, Leapfrog, and CMS star ratings.2 - Provides case management and social work oversight for SSMC and SSH ambulatory practices.a - Oversees case management and social work services across SSMC and other SSH ambulatory practices, ensuring proactive identification and management of high-risk patients including complex chronic care, SDOH needs, and care transitions.b - Rounds regularly with ambulatory nursing and practice leadership to assess case management and social work needs, coordinate team resources, and address emerging care gaps.c - Ensures appropriate and timely utilization of community resources including VNA, DME, Meals on Wheels, and behavioral health services for ambulatory patients requiring transitional or ongoing support.d - Oversees primary and specialty care referral processes to ensure timely access and continuity of care for managed populations.3 - Provides guidance and oversight for Workers' Compensation case management.a - Provides dotted-line supervisory guidance to Workers' Compensation RN case managers in Employee Health, ensuring consistent application of case management principles and SSH policies.b - Serves as a clinical resource for complex Workers' Compensation cases, facilitating coordination among Employee Health, treating providers, and third-party payers.c - Monitors Workers' Compensation case management practices against regulatory requirements and occupational health best practices, escalating concerns to the ACMO as appropriate.4 - Manages relationships with delegated and third-party case management organizations under VBC and risk contracts.a - Under the direction of the ACMO, maintains collaborative working relationships with delegated case management organizations supporting SSH's Medicare ACO population and other value-based care contracts.b - Monitors performance accountability of external case management partners, ensuring alignment with SSH quality, utilization, and care coordination goals.c - Serves as operational liaison between SSH ambulatory case management and external organizations, facilitating communication and care handoffs for shared patients.d - Maintains working knowledge of VBC contract structures, Medicare ACO population health requirements, and third-party payer case management programs relevant to SSH's risk portfolio.5 - Leads day-to-day team operations, staff supervision, and professional development.a - Supervises, mentors, and develops all ambulatory case managers and social workers; conducts performance appraisals, sets individual goals, and implements progressive discipline in accordance with HR policies as needed.b - Manages daily staffing, workload distribution, and scheduling to ensure adequate coverage across all ambulatory case management functions.c - Orients and trains new staff using SSH orientation and competency frameworks; develops individualized annual educational plans based on staff needs assessments.d - Facilitates regular team meetings to review case complexity, clinical skill development, productivity, and operational priorities.e - Maintains chart audit and documentation review processes in support of quality, compliance, and continuous improvement standards.f - Provides coverage for the ACMO and represents the department at interdisciplinary meetings and organizational committees as needed.Technology and Learninga - Participates in continued learning and possesses a willingness and ability to learn and utilize new technology and procedures that continue to develop in their role and throughout the organization.b - Embraces technological advances that allow us to communicate information effectively and efficiently based on role.