Director, Care Management

SUMMARY

The Director of Care Management is responsible for overseeing and managing Care Coordination operations to achieve clinical and social determinants of health outcomes for both the Dual Special Needs Plans (DSNP) and Accountable Care Organization Realizing Equity, Access, and Community Health (ACO REACH) membership served by Belong Health. The Director of Care Management is responsible for all Care Management functions; the development and implementation of strategies, processes, and system capabilities; coordination of resources to meet and ensure all compliance standards, service level agreements, and strategic objectives are met; and engaging in continuous process improvement techniques to improve the overall patient or member experience while also supporting improved health outcomes and quality. The Director of Care Management ensures that all Care Coordination processes seamlessly integrate with existing programs including but not limited to Provider Engagement, Quality, Population Health, and Compliance. The Director ensures programmatic compliance with all contractual requirements from Partners, state, federal and other regulatory bodies. 

ESSENTIAL JOB DUTIES AND RESPONSIBILITIES

• Motivate and inspire a high-performing and highly engaged team to provide exceptional care, compliant outcomes, and best-in-class service
• Provide oversight of and leadership to the Belong Health Care Management staff while adhering to compliance, quality and service standards and SLA’s
• Ensure compliance with partner, internal, state, and federal policies, and the applicable Model of Care
• Oversee an integrated interdisciplinary team consisting of clinical and non-clinical team members
• Monitor operational and outcomes data to inform management priorities and improvements
• Collaborate effectively with internal and external partners and provider practices to deliver innovative, repeatable, and reliable solutions
• Communicate effectively with internal and external stakeholders through the regular sharing of performance metrics, process improvements, and solution delivery
• Collaborate with other departments at Belong Health and partner organizations to improve health outcomes and quality measure performance
• Engage in continuous process and quality improvement activities to improve the effectiveness and efficiency of processes and programs
• Effectively manage multiple priorities and service delivery in a fast-paced, high-growth environment

SUPERVISORY RESPONSIBILITIES

This role has supervisory responsibilities for the Care Management staff at Belong Health.

REQUIRED PROFESSIONAL EXPERIENCE AND QUALIFICATIONS

• Experience in mid-senior management in care management or other related healthcare management environment.
• Demonstrated strategic thinking with strong collaboration skills to work effectively with a variety of external organizations and personnel.
• Experience in process improvement with an ability to devise innovative and practical solutions to solve problems; Complex Problem-solving skills.
• Experience with complex data systems, and facility with learning new systems.
• Supervisory experience including but not limited to hiring, development, monitoring and oversight, and performance management, in both remote and physical settings.
• Understanding of health plan Care Coordination requirements/compliance including Dual Special Needs Plans (DSNP), Medicaid/Medicare, Medicare Advantage.  

 PREFERRED PROFESSIONAL EXPERIENCE AND QUALIFICATIONS

• Master’s degree in nursing.
• Proven track record in delivering successful readiness reviews and audits in working with state and federal regulators.
• Experience in leading a Care Management or Care Coordination operation in a Medicaid, Medicare Advantage, and/or ACO environment.
• Experience in a high-growth company.

 EDUCATION AND TRAINING

• A Bachelor of Science in Nursing (BSN) is required; a master’s degree in nursing is preferred.

 LICENSE AND CERTIFICATION

• Active New York State Nursing License is required; multi-state nursing license preferred.
• Care management certification is required.

 WORK ENVIRONMENT

The work environment characteristics described here are representative of those encountered while performing the essential functions of this job. Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions. The noise level in the work environment is usually quiet. Most of the work is performed on a computer and in a sedentary environment.

 TRAVEL

This role may require some travel based on business needs.

PAY TRANSPARENCY

$130,000-$160,000