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Director Care Management
Director Care Management
Greensboro, NC • UM Care Management
The Director of Care Management is responsible for providing oversight to the daily functions of the Care Management (CM) Department for our Medicare Advantage (MA) products including PPO and C-SNP plans. The CM Director will assist and partner with the Vice President of CM, UM Director, and the department Medical Directors in implementing the culture and work environment that promotes and inspires an active continuous improvement philosophy in regard to providing population health-based care management programs across the continuum and population health management services for low, medium and high-risk members. The Director will provide coordination of care and services through the management of a team of care coordination staff including team leads, nurses, health care professionals, and clerical staff. Under the guidance and support of the VP, the Director will plan, select and devise care coordination operations, work methods, procedures, workflow, and standards for quality and quantity of work, including staffing standards. The CM Director will work closely with the UM Director to identify and implement an action plan for rising risk members experiencing unplanned encounters/hospitalizations. The Director is responsible to assign, direct and review the work of subordinate care management staff. Additional responsibilities include hiring and training of staff, determine personnel, material, and equipment needs to accomplish program goals.
This position requires expertise in a systems approach to problem-solving, using critical thinking skills, and excellent communication skills to plan and coordinate care.
Major Work Activities
-Coordinates care provided to a community based on population health risk stratification. Implements strategies that maximize the effectiveness of the department with the end result of improving member care and services.
-Continually assess and evaluate the knowledge and practice within the department. Provides ongoing training/feedback to staff based on productivity and quality of work being accomplished.
-Works collaboratively with UM Director, HTA Medical Directors, Quality, Pharmacy, Operations Departments to align on care for individual members as well as health plan strategies.
-Facilitates and ensures effective interdisciplinary care plan meetings
-Ensures regulatory compliance requirements are met including Medicare and C-SNP reporting
-Other duties as required.
Bachelor's degree in nursing or equivalent work experience.
Registered Nurse licensed in North Carolina or a Compact state.
Current NC RN licensure in good standing
Five years of care management experience
Three to five years management experience with proven leadership experience
Ability to lead multi-disciplinary teams while implementing and expanding a care management program
Required Knowledge, Skills, and Abilities
Knowledge of care management concept along the continuum
Knowledge of Medicare benefits
Experience and ability to use Microsoft Office products and word-processing software on a daily basis
Effective communication skills
Ability to apply clinical knowledge and experience in a care management role. Act as a subject matter expert and resource to staff.
Ability to mentor, train, and provide constructive feedback to direct reports.
Ability to support staff as they care to manage diverse populations without applying one’s own personal values
Ability to work with minimal supervision within the nursing scope of practice
Ability to think critically and analytically and work with minimal supervision.
Master’s degree in nursing or other healthcare-related fields
Case Management Certification desirable.
Knowledge and Experience in Medicare Advantage insurance area
NCQA health plan care management experience
Preferred Knowledge, Skills, and Abilities
NCQA Health plan care management requirements
Time: Full time
Updated: 6/8/2021 1:07:14 PM