• Care Management Director

    Location US-CA-Commerce
    Job ID
    2018-6111
    Category
    Management
  • Overview

    The goal of care management is to achieve member optimal level of wellness and improve coordination of care while providing cost effective, non-duplicative services. The position of Director of Care Management reports to the AVP of Care Management and is responsible for the development and implementation of AltaMed’s Care Management strategic plan, programs and services. The Director will apply best practices by implementing systems, science, incentives, and information to improve member access to services with quality outcomes. The Director of Care Management effectuates a successful support system to members that focuses on useful strategies to help them become engaged in a patient centric collaborative process that is designed to manage medical/social/mental health conditions more effectively.

     

    Responsibilities

    1. Oversees the quality of care coordination services rendered, ensuring efficient management of assignments, competency and educational needs of the Care Management staff.
    2. Effectively coordinates and controls resources to established client outcomes and management objectives
    3. Provides day-to-day oversight of Care Management operations, ensuring all practices and programs are aligned with the overall strategic plan of the organization and follow best-practice standards.
    4. Ensures all care management policies and procedures are being consistently applied within the department.
    5. Provides training to staff and addresses any gaps in policies and procedure that are identified.
    6. Establishes guidelines for safe and appropriate care planning by matching member needs with appropriate services, delivering the most effective, accessible and efficient healthcare
    7. Sets direction for Care Management staff, ensuring accountability, quality outcomes, and follow-through.
    8. Evaluates member care data to ensure that care is provided in accordance with clinical guidelines and organizational standards.
    9. Collaborates with the Sr. VP of Medical Management to promote Clinical Strategies and Initiatives to improve quality stars, services and clinical outcomes.
    10. Provides leadership and direction to direct reports.
    11. Provides input to strategic decisions that affect the functional area of responsibility.
    12. Completes corrective action plans on identified deficiencies and is responsible for creating, implementing, and monitoring changes and reporting outcomes.
    13. Works collaboratively with other Medical Management Directors to create a comprehensive member care continuum supported by inter-departmental communications, documentation principles and management, and proactive participation in daily rounds, and ICT meetings.
    14. Performs all other related duties as assigned.

     

    Qualifications

    1. Bachelor’s degree in Nursing preferred, plus a minimum of five years’ experience in managed care in the areas of care management.
    2. At least 3 years of experience in managing employees in a supervisory capacity.
    3. Current valid license as a registered nurse through the California Board of Registered Nursing required.
    4. Knowledge of clinical care practices, operations and local, state and federal regulatory standards.

     

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