Director, Care Management

It's rewarding to be on a team of people that truly believe in making an impact!

We are committed to building the best primary care environment for patients and are seeking healthcare enthusiasts to join us.

Job Summary

The Director of Care Management will oversee the care management department which includes but not limited to Care Managers and Cano at Home. The Director will implement and oversee processes to ensure a provision of high-quality health care services are being provided for a designated population (population health). Services include comprehensive care management, care coordination, health promotion, transition of care, home visits, patient satisfaction, after-hours services, referral to community and social support services, and the use of Health Information Technology. This position will work collaboratively with other departments to meet program goals, performance targets, and ensure the population is well managed in its entirety.

Essential Duties & Responsibilities

• Develop, implement, and evaluate a Care Management program that addresses the triple aims: improving patient experience, improving the health of populations, and reducing preventable utilization cost of health.

• Responsible for providing support and direct supervision to Regional Managers of Care Management.

• Assign, direct and review the work of subordinate supervisors/other nursing personnel.

• Plan, select and devise care coordination operations, work methods, procedures, workflow and standards for quality and quantity of work, including staffing standards.

• Responsible for overseeing the hiring, scheduling, evaluations, ongoing staff development, team meetings, and individual supervisory meetings.

• Plan, assign and review work of staff to ensure that group objectives are met.

• Works with the Sr. VP of Care Management to develop, analyze, and implement corporate and divisional Care Management related strategies and initiatives.

• Establishes and monitors departmental goals, objectives, and key performance indicators consistent with population needs and organization objectives, mission, vision, and values.

• Perform all other duties relevant to the position as requested.

• Monitor and track effectiveness of program performance to monitor success of key performance indicators.

• Ensure that the department is adequately staffed with the appropriate level of personnel.

• Support the Sr. VP of Care Management to identify areas of non-compliance and assure implementation of corrective action plans to address deficiencies in regions.

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Supervisory Responsibilities

• Provide supervision the Care Management Department (Care Manager and Cano at Home), including performance management, daily functions, and adherence to team policies, processes, and workflows.

Critical Results

• CR #1: > 70% HRA completion for new high-risk enrollments

• Care Management will complete > 70% of HRA's for all new high-risk enrollments

CR #2: APT 88%• Ensure Admission per Thousand are < 190 and GDR > 88%

CR #3: Readmission Rate (30d) Ensure 30-day Readmission Rate is

Best Practices

• Identify adverse trends with TOC and MRP to proactively implement effective strategies that address areas for performance improvement with care managers not meeting performance metrics

• Analyze data from Care Management Platform and Health Plan census to ensure outcomes are aligned with key performance indicators.

• Establish metrics to identify and track Care Management outcomes that support Population Health needs.

• Educate and encourage staff on the appropriate use of cost-effective ancillary services, as well as referrals and community services to support the high risk/high-cost population.

• Identify adverse trends and proactively implement effective strategies that address areas for performance improvement.

• Develop and maintain policies and procedures that are aligned with opportunities for cost savings and effective care management of population needs that supports long lasting bonds between patients and providers.

• Monitor and identify trends related to high-risk enrollments and utilization management by analyzing population health data to ensure staff workflows are aligned for obtaining positive key performance metrics.

• Establish relationships with other departments, market leaders, delegated vendors, and other health plan/vendor stakeholders to align population and organizational needs/initiatives.

Education & Experience

• Valid Registered Nurse license required; with two years of relevant experience, which can include any employment experience and is not limited to case management/service coordination duties.

• Requires a bachelor’s degree with a minimum of three (3) to five (5) years of relevant management experience.

• Minimum of 3 years of experience in Utilization review, Discharge planning and / or Case Management

• Managed Care experience preferred

• Certification in Care Management (preferred)

• Bi-lingual: English and Span