Job Description

The Director Care Management plans, establishes, and directs the overall programs for the Care Management departments including behavioral, maternal, pediatric, and adult for all populations and lines of business with a focus on population health. Provides operational supervision of all care management activities. Responsibilities include proactive planning, organization, and oversight of care management, disease management, behavioral health and special needs program activities, ensuring the highest quality care and services are provided in the most efficient manner. The Director Care Management focuses on developing, managing, and monitoring interventions to achieve positive outcomes in health plan and program operations.

  • Develop department structure and programs which integrate behavioral and physical care management services for our members
  • Serves on the Medical Management Committee and reports program outcome metrics
  • Responsible for departmental planning and goal setting
  • Provides clinical supervision and personnel management
  • Implements quality improvement initiatives
  • Prepares annual budget and ensures fiscal accountability
  • Develops policies and procedures
  • Providers leadership to functional area managers
  • Provides organization-wide leadership to meet regulatory and accrediting standards
  • Revises the Care Management Program descriptions annually or as indicated by contract or accreditation requirements and conducts annual evaluation of programs per contract or regulatory requirements.
  • Contributes to the Medical Management, Maternal, and EPSDT annual Plans and Work Plans for the Medicaid regulator. Ensures goals and outcomes are documented quarterly.
  • Strategic thinker who develops population health initiatives and programs
  • Analyzes data; communicates results to senior leadership; develops action plans for performance improvement

Education:

Masters in Nursing

Years of Experience:

5-10 years

Specialized Knowledge:

  • Managed Care; Medicaid, Medicare D-SNP, population health; physical and behavioral health

Education / Experience / Other Requirements

Application Instructions

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