Director Care Management (RN - Delaware)
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Wilmington, DE 19806
Gateway Health Plan
Job Description :
I. GENERAL OVERVIEW:
Director of Care Management will develop and ensure execution of the strategic and operational plans for care management and special needs program development, delivery and evaluation. Accountable for all aspects related to care delivery, member outcomes, and financial performance goals. Provides leadership to support effective care management processes and programs for members with complex medical, behavioral and psychosocial needs. Special attention is given to those identified as high profile or sensitive by internal sources, DPW, CMS, or other external entities. Oversees development, implementation and evaluation of Disease Management and Preventative Health Programs and outreach/interventions with members. Ensures collaboration with program development, care management and external agencies to identify member need and develop program content related to clinical or psychosocial conditions/risk factors. Establishes and monitors goals, benchmarks, and work plans for projects to ensure consistency with corporate and departmental objectives and measurable outcomes. Develops and implements annual department budget and staffing plans.
II. ESSENTIAL RESPONSIBILITIES:
1. Directs all management activities for Care Management Departments.
+ Ensures staff compliance with internal and external regulatory requirements and profession practice standards.
+ Recruits and approves hiring of staff; performance management; coaching, training and resource planning of staff; ensures departmental staffing supports the corporate standards.
2. Develops, gains approval for and implements strategic plan and annual operating plan. Monitors all aspects of the care management process, including but not limited to, assessment, care plan development, interventions, and quality management.
3. Ensure implementation and measurement of care management performance standards. Develops and implements policies, procedures and trainings to ensure compliance and effective service/program delivery.
4. Identifies, develops and implements process improvements which are focused on quality, utilization, cost containment and outcomes.
5. Oversees and approves research and development of programs that improve clinical outcomes and member satisfaction. Ensure appropriate and cost effective utilization of health care resources, including the integration and evaluation of quality of care measures.
6. Accountable for outreach delivery and measurement of impact. Ensures new and existing program review evaluation.
7. Develops and implements annual department budget and staffing plan.
8. Other duties as assigned or requested.
+ Bachelor’s degree in Business or health related field OR 7-10 years care/case management experience
+ 5 years’ experience in managed care, specifically in case management, utilization management and/or discharge planning
+ 5 years previous supervisory/management experience
+ RN – licensed in Delaware
+ Master’s degree
+ CCM – Certified Case Manager
IV. SCOPE OF RESPONSIBILITY
Does this role supervise/manage other employees? Yes
V. WORK ENVIRONMENT
Most company positions are performed in a normal office environment. Please use this section to describe unusual work conditions, such as exposure to high noise levels, temperature extremes, etc. If "none, "please indicate with “Not Applicable.”
Is Travel Required?
This job requires the ability to work as a team member. Additionally, this job requires the willingness and ability to report to work on a regular and timely basis and may require irregular work hours, holidays and/or weekends.
Employee Referral Level: 4
Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities, and prohibit discrimination against all individuals based on their race, color, religion, sex, national origin, sexual orientation/gender identity or any other category protected by applicable federal, state or local law. Highmark Health and its affiliates take affirmative action to employ and advance in employment individuals without regard to race, color, religion, sex, national origin, sexual orientation/gender identity, protected veteran status or disability.
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Req ID: J146768