Director, Case Management

3 months ago

Wheeling, United States The Health Plan of West Virginia Inc Full time
Job DescriptionJob Description

The Director of Case Management provides leadership, management, oversight, and assessment of all aspects of clinical program management and is responsible for ensuring quality provision of member driven care continuum programs while ensuring delivery of essential services that address the total health care needs of The Health Plan members. The Director of Case Management works collaboratively with the VP of Clinical Services, Director of Utilization Management, AVP of Population Health and the Medical Directors, as well as other interdisciplinary team leaders to plan, organize, coordinate, develop the vision, perform implementation and measure the outcome of all population health driven, care continuum programs based on both governmental and non-governmental lines of business to ensure compliance to the requirements of all regulatory and accreditation bodies relevant to clinical management.

Required:

  1. Registered Nurse with a minimum of 5 years clinical experience.
  2. At least two years of experience should be in a management capacity.
  3. Minimum of a Bachelor's of Science degree in Nursing or willingness to obtain within 2 year of hire.
  4. Holds active and unencumbered Ohio or West Virginia multi-state registered nurse license.
  5. Minimum of five years in a managed care organization.

Desired:

  1. Should possess public speaking and excellent written communication skills, motivation and initiative, and ability to work independently.
  2. Should possess superior work ethic.
  3. Experience in writing policies and procedures.
  4. Proven leadership abilities.
  5. Should possess strong verbal, written, analytical, and interpersonal skills.
  6. Should be flexible and able to multi-task, work in a fast paced environment and adapt to changing processes.
  7. Self-starter with strong entrepreneurial skills.
  8. Certification in related area preferred, Certified Case Manager (CCM).

Responsibilities:

  1. Oversees medical and Care Continuum operations.
  2. Provides direct supervision to the managers and supervisors.
  3. Develops and monitors medical management staff care continuum training program.
  4. Participates on all clinical services committees.
  5. Development and continual review and revision of all care continuum processes, policies and procedures within the department.
  6. Develops and enhances system of management reporting and metrics to be utilized for productivity, adherence, and outcome measurements to provide relevant information on overall effectiveness in care continuum areas.
  7. Ensure department optimizes care continuum work flow efficiencies to meet company objectives
  8. Ensures that all medical care continuum programs are delivered consistent with applicable internal policies and procedures as well as applicable CMS, BMS, NCQA or other regulatory agency requirements.
  9. Ensures appropriate care continuum programs are in compliance to quality outcomes e.g. STAR measures, HEDIS, CCIP, QIP and PIPs.
  10. Responsible for medical management/behavioral health annual risk assessment related to care continuum programs.
  11. Collaborates with the CMO, VP of Clinical Services, Director of UM and AVP of Population Health on initiatives and interventions to ensure cross-functional and inter-departmental alignment with organizational goals.
  12. Leads medical management and behavioral health care continuum program integration with provider health systems.
  13. Implements and monitors medical management and third party care continuum program software.
  14. Provides input into clinical services medical/evidence based care continuum program criteria.
  15. Leads clinical services care continuum program compliance and NCQA initiatives.
  16. Interacts with government agencies, health systems, and employer groups to facilitate medical care program integration.

  • Medical Director

    3 months ago

    Wheeling, United States The Health Plan of West Virginia Inc Full time

    Job DescriptionJob DescriptionMedical Professional(s) responsible for direction and oversight of healthcare services provided to Plan members to ensure the delivery of cost-effective, quality services. The Medical Director shall be responsible for Medical Direction of all activities of the Quality Management and Utilization Management Programs of The Health...

  • Manager, Utilization Management

    4 weeks ago

    Wheeling, United States The Health Plan of West Virginia Inc Full time

    Job DescriptionJob DescriptionA Manager within Clinical Services is responsible for overseeing day to day operation of the clinical staff for Medical Utilization Management for all lines of business. They are responsible for ensuring proper staffing levels, work assignments, performance evaluation of staff, serving as a subject matter expert on benefits,...

  • Facilities Management Director

    5 days ago

    Wheeling, Illinois, United States Sodexo Full time

    Job Title: Director of Facilities ManagementWe are seeking a highly skilled and experienced Director of Facilities Management to join our team at Sodexo. As a key member of our operations team, you will be responsible for leading our facilities maintenance operations and ensuring the delivery of strategic and operational objectives.Key Responsibilities:Lead...

  • Corporate Environmental Health Director

    3 days ago

    Wheeling, Illinois, United States U.S. Tsubaki Power Transmission, LLC Full time

    Job Title: Corporate Environmental Health DirectorU.S. Tsubaki Power Transmission, LLC is seeking a highly skilled Corporate Environmental Health Director to join our team. As a key member of our organization, you will be responsible for directing and providing environmental, health, and safety (EHS) program oversight across our company.Key...

  • Director of Facilities Management

    2 weeks ago

    Wheeling, Illinois, United States Sodexo Full time

    Job DescriptionJob Summary:Sodexo is seeking a highly skilled and experienced Director of Facilities Management to join our team. As a key member of our facilities management team, you will be responsible for providing leadership and direction to our facilities teams in delivering safe, sanitary, and innovative services to our clients.Key...

  • Director of Facilities Management

    2 weeks ago

    Wheeling, Illinois, United States Sodexo Group Full time

    About the Role:Sodexo Group is seeking a highly skilled and experienced Director of Facilities Management to join our team. As a key member of our operations team, you will be responsible for leading our facilities maintenance operations and providing strategic and operational objectives to reduce facility costs, improve productivity, and enhance the image...

  • **Director of Facilities Management**

    2 weeks ago

    Wheeling, Illinois, United States Sodexo Full time

    About the Role:We are seeking a highly skilled and experienced Director of Facilities Management to join our team at Sodexo. As a key member of our operations team, you will be responsible for leading our facilities maintenance operations and ensuring the delivery of strategic and operational objectives.Key Responsibilities:Client Communication: Serve as the...

  • Director/Manager Financial Reporting

    6 days ago

    Wheeling, United States Robert Half Full time

    Job DescriptionJob DescriptionTo apply to this role, please send your resume to Valerie Herron at valerie.herron@roberthalf.c0mWe are looking for a Director/Manager Financial Reporting to join our team in Wheeling, Illinois. In this role, you will be tasked with leading key financial processes, overseeing planning and forecast models, and managing the...

  • Behavioral Health Medical Director

    2 days ago

    Wheeling, West Virginia, United States The Health Plan of West Virginia Inc Full time

    Job Title: Behavioral Health Medical DirectorJob Summary:The Behavioral Health Medical Director position at The Health Plan of West Virginia Inc. is a key role that involves providing clinical guidance to the Behavioral Health Care Coordination and Utilization Management teams. The successful candidate will be responsible for facilitating integrated BH...

  • Executive Director

    1 week ago

    Wheeling, West Virginia, United States House of The Carpenter Inc Full time

    About the RoleThe House of the Carpenter is seeking a highly skilled and compassionate Executive Director to lead our mission project. As a key member of our team, you will be responsible for overseeing the daily operations of our organization, ensuring the successful implementation of our programs, and fostering strong relationships with our...

  • Case Worker- Ohio Co

    4 months ago

    Wheeling, United States Youth Services System Full time

    Job DetailsJob Location Hazel Atlas - Wheeling, WV Position Type Full Time Education Level 2 Year Degree Travel Percentage Up to 50% Job Shift Any Job Category Nonprofit - Social Services DescriptionQUALIFICATIONS: Bachelor's Degree in Social Work or related field required. Two years experience with target population preferred. Valid Driver's License and...

  • Regional Sales Director

    2 weeks ago

    Wheeling, West Virginia, United States CommuniCare Family of Companies Full time

    Job SummaryWe are seeking a highly skilled Regional Sales Director to join our team at CommuniCare Family of Companies. As a key member of our sales team, you will be responsible for developing and executing sales strategies to promote census growth and drive business development in our markets.Key ResponsibilitiesCensus Development: Collaborate with our...

  • Director, Corporate Environmental Health

    3 weeks ago

    Wheeling, United States Disability Solutions Full time

    Description:The TSUBAKI name is synonymous with excellence in quality, dependability and customer service. U.S. Tsubaki is a leading manufacturer and supplier of power transmission and motion control products. As a part of a vast, international network of corporate and industrial resources, Tsubaki offers its customers the finest state-of-the-art products...

  • Director of Banquets

    4 months ago

    Wheeling, United States Oglebay Full time

    Job DescriptionJob DescriptionSUMMARYThe Director of Banquets is responsible for planning, organizing, supervising, and coordinating the activities of the banquet department to ensure optimum performance, exceptional guest service and maximum profitability of all functions. ESSENTIAL DUTIES AND RESPONSIBILITIES include the following. Other duties may be...

  • Health and Wellness Director

    7 days ago

    Wheeling, United States Franciscan Ministries Full time

    Overview: Health and Wellness Director Highly Competitive Salary Addolorata Villa Wheeling, ILAward Winning Senior Living Community  We love our Staff!  THAT’S WHY WE OFFER… PayActiv – Immediately access up to 50% of your earned payTax Free Student Loan ForgivenessGreat Health PlansEmployer Funded Health Savings AccountCompany Paid Life...

  • News Director

    3 weeks ago

    Wheeling, United States Nexstar Media Group Full time

    The News Director leads and supervises all aspects of news, weather and sports programming production. • Manages all aspects of the News Department (other than Production) • Plans and manages staffing, training, and performance evaluations for the News Department. • Makes decisions regarding hiring, evaluation, promotion and termination of...

  • Health and Wellness Director

    5 days ago

    Wheeling, United States Franciscan Ministries Full time

    Health and Wellness DirectorAt Franciscan Ministries, we are seeking a highly skilled and compassionate Health and Wellness Director to join our team at Addolorata Villa, a vibrant senior living community in Wheeling, Illinois.Key Responsibilities:Provide clinical oversight to the wellness team and ensure delivery of quality care to all residents.Oversee and...

  • Director, Corporate Environmental Health

    7 days ago

    Wheeling, United States US Tsubaki Power Transmission LLC Full time

    U.S. Tsubaki is a leading manufacturer and supplier of power transmission and motion control products.The Corporate EHS Director is responsible for directing and providing environmental, health, and safety (EHS) program oversight across Tsubaki.The Corporate EHS Director monitors and documents the effectiveness of safety control measures used throughout the...

  • Director, Audit

    2 months ago

    Wheeling, United States The Health Plan of West Virginia Inc Full time

    Job DescriptionJob DescriptionThis is a HYBRID position.Serves as the organization’s internal auditor and advisor to the Board of Directors, Audit & Corporate Compliance Committee and Executive Management Team, providing independent assurance that the internal control processes are suitably designed and operating effectively. Develops, executes and...

  • Executive Director of Operations

    3 weeks ago

    Wheeling, West Virginia, United States PAN American Group Full time

    About the RoleWe are seeking a highly skilled and experienced Executive Director of Operations to join our team at PAN American Group. As a key member of our leadership team, you will be responsible for providing strategic direction and oversight to our restaurant operations.Key ResponsibilitiesLead and manage a team of restaurant managers and staff to...