The Director of Care Management will be responsible for identifying gaps and barriers in the delivery of the care management model and lead the implementation of agreed to solutions. The Director will leverage knowledge of data, systems, processes and programs to provide the operational oversight. The Director of Care Management will be responsible for collaborating with departmental Directors and managers to create budgets and develop business plans.
Responsibilities and Duties:
- Provide leadership to ensure the provision of member centered care management with efficient and cost effective operations in conjunction with the AVP, Care Management and in collaboration with the Care Management leadership team.
- Monitor the day-to-day operations of care management to ensure smooth progress toward managing quality of care, adherence to compliance with standards and improving overall operations.
- Evaluate overall performance of the care management programs by gathering, analyzing and interpreting data and metrics.
- Create process and dashboards that represent improved clinical and business processes through analysis and collaboration with the care management leaders.
- Lead special projects and support clinical projects by ensuring all reports are completed timely and adhere to regulatory standards and Healthfirst policies and procedures.
- Collaborate with care management leaders to develop budget planning, preparation and adherence along with budget reforecasting.
- Responsible owner for all the Care Management Partnership Service Level Agreements and key performance indicators (KPIs). Collaborates with the various departments ;i.e. Clinical Eligibility, Care Management, Finance, and Ancillary to ensure all SLAs are adhered to , revised and updated, and reaffirmed by the partnerships routinely.
- Participate and assist in long term business planning at the managerial and executive level for the Integrated Product Lines
- Co-owner of the Quality Health Incentive Program (QHIP), with the collaboration of the Population Health Department. Ensures the yearly QHIP goals and initiatives are directed and implemented to the responsible recipients timely.
- Responsible for the welcome and enrollment and disenrollment activities of member coming on the plan’s Integrated Product lines.
- Performs other activities as assigned
- A Licensed New York State RN with Bachelor’s Degree from and accredited institution or LMSW or LCSW is required.
- Advanced Degree.
- Knowledgeable of Department of Health (DOH) and Center for Medicare & Medicaid Services (CMS) regulations.
- Must have prior experience working with one or more Medicaid managed care plan products, such as FIDA, Medicaid Advantage Plus (MAP) and Managed Long Term Care (MLTC). .
- Ability to interact and translate business needs in presentations across clinical and the larger organization. .
- Knowledge and understanding of commercial populations.
- Knowledge of National Committee for Quality Assurance (NCQA) accreditation requirements.
- Ability to use Microsoft Excel to perform pivot tables, V-lookups and macros.
- Ability to use PowerPoint to design, create hyperlinks, design, create graphics and convert spreadsheets.
- Ability to analyze large amounts of data, interpret trends and drive process improvement across a multi-platform complex organization.
WE ARE AN EQUAL OPPORTUNITY EMPLOYER. Applicants and employees are considered for positions and are evaluated without regard to mental or physical disability, race, color, religion, gender, national origin, age, genetic information, military or veteran status, sexual orientation, marital status or any other protected Federal, State/Province or Local status unrelated to the performance of the work involved.
If you have a disability under the Americans with Disability Act or a similar law, and want a reasonable accommodation to assist with your job search or application for employment, please contact us by sending an email to [email protected] or calling 212-519-1798 . In your email please include a description of the accommodation you are requesting and a description of the position for which you are applying. Only reasonable accommodation requests related to applying for a position within Healthfirst Management Services will be reviewed at the e-mail address and phone number supplied. Thank you for considering a career with Healthfirst Management Services.
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