Sarasota, Florida
Director of Care Management Job Opening in Sarasota, Florida - Multi-Specialty Medical group is seeking strong candidates for the Director of Care Management Role . The Director is responsible for implementation of programs supporting population health management, and quality improvement within the organization. The Director of Care Management must demonstrate accountability for the quality results, project profitability, and patient satisfaction.
The position is responsible for the oversight, management and optimization of all quality improvement, utilization management and care management activities for patients in the post-acute setting (skilled nursing facility and in the home). The Director of Care Management manages staff directly responsible for the day-to-day operations of the care management programs.
Essential Functions:
Provide assistance in developing and implementing care management initiatives to achieve overall program goals.
Closely monitors and analyzes outpatient reports and identifies trends. Develop and execute solutions to improve all resource management.
Facilitates team process problem resolution using HCP administration, Medical Directors, Contracting, Risk Management, Behavioral Health and health plans regarding complex patient issues. Implements the results of the collaboration process.
Monitors all high risk/high cost patients in regard to care delivery, referrals, etc.
Identifies opportunities for the development of new care management approaches.
Provides supervision and guidance to staff reporting to the position.
Conducts staff meetings including utilization management review outcome measurements (ADK, re-admit rate, LOS in SNF) and identification of opportunities. * Identifies, develops and oversees the educational needs of Care Management staff, providers and others. This can include an extensive orientation program, cross-training and proactive approach to case management.
Ensure that all operational processes that are implemented are in compliance with all federal, state and accrediting body standards.
Demonstrates, by action and attitude, the standard of high staff and physician satisfaction, treating staff and physicians with respect * Uses, protects, and discloses HCP patients' protected health information (PHI) only in accordance with Health Insurance Portability and Accountability Act (HIPAA) standards.
:
RN with current, unrestricted license in the state of Florida
Education:
Bachelor's degree from a four-year college and/or a professional certification requiring formal education beyond a two-year college.
MBA/MPH/MHA preferred
Experience:
10+ years of professional experience required; minimum 5 years experience in healthcare, working with providers and/or payers at a management level.
Experience managing operating departments in hospital/health systems.
Experience providing strategic leadership, managing teams and leading projects required.
Knowledge, Skills, and Abilities:
Knowledge of CM regulations that fall under CMS, NCQA, DMHC and other applicable state and accreditation standards.
Commitment to service excellence and patient satisfaction.
Ability to develop and maintain effective working relationships with other teammates, patients and the general public.
Ability to multi-task in a fast-paced clinical setting.
Excellent verbal, written and interpersonal communication skills.
Aptitude for coaching, training and developing new teammates.
Ability to collaborate and build strong client relationships across all levels of the organization including clinical staff, physicians and administrative leadership to meet deliverables.
Experience working with Medicare Advantage Population preferred
Job Type: Full-time
Required education:
Bachelor's
Required experience:
healthcare: 5 years
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