Kalamazoo, Michigan
Care Management Ops, Director Job Opening in Kalamazoo, Michigan - Our client delivers comprehensive care to Medicare, Medicaid, and complex-needs patients. For over a decade, they have provided extraordinary outcomes for thousands of people in these underserved groups. They are seeking a Care Management Operations, Director.
Job Summary: The Director, Care Management Operations reports to the VP, Care Management and is a regional position that will support and guide regional care management functions in a fast paced, growth oriented population health organization. This dynamic role will support and manage a team to drive exceptional patient outcomes for a complex patient population using innovative technology solutions in a multidisciplinary care setting. This role will be accountable to achieve exceptional service and meet contract commitments to health plan partners and regulators, and drive project implementation activities and best practice policies and processes. The role will recruit and manage a range of care management professionals, including clinical and non-clinical positions, who collaborate to serve a diverse membership base. This seasoned leader will monitor performance quality and performance metrics while also providing recommendations on operational design and efficiencies. The position will also collaborate with other stakeholders and functional areas.
Responsibilities:
Responsible for the development and execution of care management activities to drive compliance with health plan partners? models of care
Develops and maintains collaborative relationships with other internal market leaders, payor partners, regulators and corporate teams
Leads cross-functional clinical and non-clinical meetings and other projects
Functions as market care management leader during implementation as needed to accommodate organic and new product growth
Monitors care management clinical operations as well as contractual and regulatory operational requirements during implementation and post-implementation to drive compliance, quality outcomes and operational efficiencies
Functions as care management subject matter expert, understands and maintains knowledge of delegated lines of business and community provider relationships
Monitors staffing and budget for care management
Supports and oversees care management acuity assignment methodology, including supporting new technology development by defining business for clinical operations
Oversees risk stratification guidelines compliance through reviews of care management activities and systems reporting * Identifies and executes on best practices for care plan development and management * Responsible to support achievement of cost, quality, and patient/member experience goals
Leads the care management and social work teams ensuring they are effectively and efficiently operated, resourced and performance managed by market leadership
Directs, plans and evaluates care management documentation quality through independent reviews and through the monitoring of the internal quality review tool(s)
Develops care management policies, procedures or other job aides as needed
Participates in collaborative meetings between care center staff/providers and care management across all markets, leads clinical operations oversight meetings and maintains agenda and written meeting minutes
Develops performance improvement plans or other quality monitoring tools to support performance expectations for all staff
Tracks and reports to supervisors and other market or corporate leadership using systems reports on a defined frequency, taking efforts to validate accuracy and completeness on a regular basis
Participates in personnel management including recruiting, hiring, goal setting, evaluations and team building
Promotes a positive work environment, sets an atmosphere of open communication and feedback
Performs, at a minimum, an annual assessment of operational performance across all key success metrics
Other duties as assigned
Qualifications:
3-5 years Health Plan care management experience required.
Experience with MMP and/or DSNP programs required. Healthcare provider experience preferred.
Ability to travel 15%, mostly within the state.
Ability to work in a Windows based computing environment.
Strong interpersonal and critical-thinking skills.
:
RN required, Bachelor?s degree required, Advanced degree preferred.
Language Ability:
Ability to read and interpret documents such as safety rules, operating and maintenance instructions, and procedure manuals.
Ability to write routine reports and correspondence. Ability to speak effectively before groups of customers or employees of organization.
Math Ability:
Ability to add, subtract, multiply, and divide in all units of measure, using whole numbers, common fractions, and decimals.
Ability to compute rate, ratio, and percent and to draw and interpret bar graphs.
Reasoning Ability:
Ability to apply common sense understanding to carry out instructions furnished in written, oral or diagram form.
Ability to deal with problems involving several concrete variables in standardized situations.
Computer Skills:
Must be able to proficiently use Microsoft Office skills and clinical applications.
Competencies:
Active Listening - Carefully and respectfully paying attention to what others have to say. Expressing interest using appropriate verbal and nonverbal responses. Filtering out distractions, withholding judgment and verifying understanding.
Attention To Detail - Taking great care to ensure all aspects of work are completed correctly, developing effective methods for tracking specifics, and checking the quality of one?s work in order to ensure accuracy. Identifying mistakes and correcting them before they cause major problems.
Commitment ? Passionately and enthusiastically demonstrating a dedication to the organization. Aligning one?s behavior with the organization?s goals and ideals.
Compassion ? Striving to understand the feelings of others and demonstrating this to the individual by reinforcing and validating their feelings. Possessing emotional maturity and awareness that allows one to express genuine concern and caring toward others.
Customer Focus/ Patient Focus ? Paying careful attention to patient needs and taking action in order to meet or exceed patient expectations. Treating patients with a high level of respect and appreciation. Effectively handling difficult patient interactions and resolving customer problems.
Dependability ? Being reliable and punctual and following through on commitments. Making arrangements in advance when taking allowable days off. Promptly notifying employer when illness or other serious events may cause tardiness or inability to show up for work.
Initiative ? Being proactive rather than reactive in thought and in action. Being a self-starter rather than waiting for direction from others. Seeking out opportunities for continuous learning in order to expand one?s role and increase one?s contribution on the job.
Interpersonal Skills ? Demonstrating a pleasant disposition and friendly demeanor when interacting with others. Putting others at ease and refraining from acting defensively or being confrontational. Cooperating with and treating others with respect.
Multi-tasking ? Effectively performing multiple responsibilities simultaneously and/or frequently moving from one activity to another without losing focus. Being able to perform a variety of tasks without becoming overwhelmed or confused or forgetting to complete an assignment.
Safety ? Being aware of factors that affect employee safety and adhering to all rules and regulations intended to protect employees from harm. Using good judgement in all work situations that could potentially affect anyone?s safety. Taking action to correct safety hazards and anticipating and addressing potentially unsafe situations.
Sensitivity to Diversity ? Interacting with others in ways that are socially appropriate and reflect an understanding of and respect for the differences of all individuals. Being sensitive to and valuing the differences, beliefs, and viewpoints of others.
Teamwork ? Cooperating and working effectively with others in the pursuit of common goals. Shows willingness to interact in groups. Trusts and respects others and behaves in ways to generate a positive collaborative environment. Makes attempts to work with others, even if they are combative
Job Type: Full-time
Salary: $130,000.00 to $150,000.00 /year
Required experience:
Health Plan care management: 3 years
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