Clinical Program Director
3 weeks ago
The Director of Case Management and Operations provides strategic leadership and oversight to clinical program management, ensuring the delivery of high-quality, member-driven care continuum programs that meet the total healthcare needs of The Health Plan members.
Key Responsibilities:
- Develop and implement clinical program strategies to improve healthcare outcomes and reduce costs.
- Collaborate with interdisciplinary teams to plan, organize, and coordinate care continuum programs.
- Ensure compliance with regulatory requirements, including CMS, BMS, NCQA, and other relevant agencies.
- Develop and monitor medical management staff training programs to enhance care continuum skills.
- Participate in clinical services committees to drive quality improvement initiatives.
- Develop and maintain metrics to measure productivity, adherence, and outcome measurements.
- Ensure departmental workflow efficiencies meet company objectives.
- Collaborate with CMO, VP of Clinical Services, Director of UM, and AVP of Population Health to align initiatives with organizational goals.
Requirements:
- Registered Nurse with a minimum of 5 years clinical experience.
- At least two years of experience in a management capacity.
- Minimum of a Bachelor's of Science degree in Nursing or willingness to obtain within 2 years of hire.
- Holds active and unencumbered Ohio or West Virginia multi-state registered nurse license.
- Minimum of five years in a managed care organization.
Desired Qualifications:
- Superior work ethic and ability to work independently.
- Strong verbal, written, analytical, and interpersonal skills.
- Experience in writing policies and procedures.
- Proven leadership abilities.
- Flexibility and ability to multi-task in a fast-paced environment.
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