- The Director of Care Management is a key Partner with Health Plans leadership, actively contributing to the development and implementation of care management strategic plans, goals, and objectives. These plans are crucial in aligning the Health Plan and Nascentia Health's overall strategic goals, and the Director ensures their successful implementation within the business units to support the growth and profitability of the plan.
- Participates in developing, revising, and implementing care management policies and procedures to ensure alignment between processes and Federal and NYS health plan regulations.
- Is a key collaborator with the quality and utilization departments, working to set quality goals and establish methods and tools for staff audits, evaluations, and assessments.
- Monitors overall results, identifies trends, reports on findings, and recommends improvements. Identifies, monitors, and evaluates key performance indicators, trends, and needs of members and member services; develops strategies to address areas of opportunity for improvement.
- Ensures clinical criteria and guidelines are implemented consistently.
- Collaborates with the Education Department to identify/update staff orientation and ongoing training needs. Assesses orientation and training programs to ensure effectiveness.
- Ensures infrastructure efficiencies that enable delivering operationally excellent, high-quality services.
- Provides oversight of care management functions delegated to vendors, including, but not limited to, care management, quality, and utilization metrics. Identifies areas of concern and coordinates with contracted vendors of corrective action plans, as appropriate.
- Develops and supports relationships with providers that result in continued improvement in quality healthcare outcomes. Drives efforts to engage providers in collaborative efforts during care transitions.
- Interprets and enforces Health Plan policies and procedures.
- Performs all duties inherent in a senior managerial role. Ensures effective staff training/cross-training, evaluates staff performance, and approves hiring, promotions, salary actions, and terminations.
- Participates in special projects and performs other duties as assigned.
- An experienced Current New York State Licensed Clinician or RN with a Managed Care Plan background, experience in MLTC and/or Medicare Advantage Plans, with an emphasis on Care/Case Management and manager-level experience.
- A bachelor's degree in nursing or social work is required.
- Current and valid driver's license and auto insurance, and a vehicle which can be used for work.
- Self-directed and organized with the ability to work independently in a fast-paced environment.
- Proficient computer skills (including knowledge of electronic medical records software) with ability to learn new software.
- Exceptional oral, written, and verbal communication skills.
- Must possess a proactive attitude, be self-motivated, willing to take initiative while also being a team player.
- The position is a hybrid, with a work-from-home option and some required time in an office setting.
- Ability to sit or stand at a desk 90% of the day.
- Ability to drive-in All-weather conditions (rain, sleet, snow, wind).
- Visual/hearing ability sufficient to comprehend written or verbal communication.
- Ability to use telephone and communicate over the phone.
- Frequently uses a laptop computer for core role responsibilities.
- Bloodborne Pathogens Exposure Category III - Employee who rarely has contact with blood and body fluids.
- Retention Bonuses
- Internal Mentoring Program
- 401K with generous Employer match
- On-Site Gym (free for all employees)
- Potential Hybrid Position (Partial Work From Home)
- Medical, Dental, Vision plans
- Tuition Reimbursement
- Partially funded HSA
- Employee Recognition Platform
- Paid Time Off, Holidays, Sick and Extended Sick Leave
- Short/Long term Disability
- Employee Assistance Program (EAP)
- Much More
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Director of Care Management - Rochester, United States - Nascentia Health
Description
Position Description:The Director of Care Management plays a pivotal role in our organization, providing management oversight and leadership to the Clinical Team Supervisors and Care Management Teams of the Nascentia' s health plans. They are instrumental in ensuring support, quality care, and cost-effective services, working closely with a team of clinical staff and healthcare leaders to drive optimal patient outcomes.
Performance Responsibilities and Standards:
Competitive Salary [This position is an S07 exempt position with a min-max rate of: $101,213 -$157,449/annually] with:
Nascentia Health is leading the way in home care, post acute care and long-term community health. A healthcare system without walls, Nascentia is an innovator in the concept of healthcare, truly focused on the patient as a whole. By serving people in their homes, Nascentia Health is able to provide true holistic care. We can address immediate needs, help support positive long term medical and lifestyle choices that provide for better outcomes, leverage cutting edge in-home care technologies, and help avoid unnecessary visits to busy healthcare facilities.
Our employees are our greatest asset. They work hard every day to make our system amazing and are dedicated to our mission of being the premier home and community-based care system for the regions we serve. We want everyone to love what they do, be excited about coming to work, and take pride in being part of our team.
Nascentia Health is an Equal Opportunity Employer (EOE)
Employment is contingent upon negative results of a pre-hire drug screen and background check clearance
