Director – Care Management

Director – Care Management

Requirements

• Requires a Bachelor’s degree and 7+ years of related experience, including prior management experience.
• Current state’s Registered Nurse (RN) license preferred
• Previous Managed Care (Medicare) experience highly preferred
• Previous Director level experience preferred

Responsibilities

• Directs and evaluates departmental operations, including the care management model, staffing, use of information technologies, and staff competencies to achieve performance and quality objectives
• Oversees care management team on performance, improvement, and talent management
• Sets goals and objectives for care management team and oversees care management data and reporting metrics to achieve quality and cost-effective healthcare results and working with senior leadership, as required
• Oversight of the development and implementation of care management policies and procedures within the care management team to ensure compliance with regulatory requirements for federal, state, and National Committee for Quality Assurance (NCQA) standards, as required
• Stays up to date on latest trends and best practices in Payer Care Management and related fields and attends conferences, as required
• Leads process improvements for the care management team to achieve quality and cost-effective healthcare results and working with senior leadership, as required
• Contributes to the development and improvement of clinical care pathways that enhance cost effectiveness while providing quality care
• Develops care management strategies and influences decisions by providing recommendations that align to organizational objectives
• Develops department budget while collaborating inter-departmentally and with senior leadership
• Develops the overall strategy for onboarding, hiring, and training new care management team members to ensure adequate training and high quality-care to improve member and/or provider experience and ensure compliance
• Performs other duties as assigned
• Complies with all policies and standards

Preferred Qualifications

No preferred qualifications provided.