Director, Care Management
7 days ago
The Job
Responsible for designing care management strategy, implementing care management programs for SCAN Special Needs Plans and other SCAN products across all markets, overseeing operational care management teams, and collaborating with internal stakeholders as well as external stakeholders and provider groups. The Director will drive program development, cross-functional collaboration, and operations to ensure the delivery of high quality, evidence-based care as well as drive provider and member engagement to achieve department goals. In addition, the Director is responsible for ensuring ongoing compliance with all regulatory and accreditation requirements.
You Will
Defines and leads implementation of care management strategy (inclusive of case management, complex care management, disease management) and synthesizes cross-functional inputs to build cohesive strategic plan. Develops and implements operational business plans and departmental objectives to support organization strategies and evaluates existing programs to determine if enhancements are needed or new programs are to be implemented.
Provides oversight of the care management team and develops goals, objectives, and action plans for assigned staff, which includes management responsibility for hiring, performance reviews, salary reviews, and addressing disciplinary matters. Coordinates care management activities with SCAN and Provider Group leadership and fosters collaboration with external stakeholders.
Promotes appropriate use of resources that aligns with organizational and/or departmental goals and objectives and develops and maintains budgets.
Coordinates with Medical Directors and internal business and IT stakeholders for program development; in addition, promotes the use of care management regulatory and best practices criteria for clinical decision making.
Partners with health data and analytics teams to build out risk stratification tools and customized reporting and data dashboards that track and monitor key performance metrics, including clinical and non-clinical outcomes and Star metrics.
Hires, trains, and coaches managerial and supervisory staff. This includes fostering of staff development, ownership, accountability, educational opportunities, team building, and career development.
Ensures that department policy and procedures, desktop procedures, workflows, job aides, training materials, are current and accurately reflect processes in order to provide consistent quality care and meet compliance with regulatory and department requirements.
Builds effective professional relationships with providers and other internal and external partners utilizing verbal and written communication skills, developing trust, meeting timelines, respecting cultural differences, using active listening skills, and maintaining confidentiality.
Serves as a subject matter expert and represents the department at assigned committees and facilitates staff meetings and interdisciplinary team meetings including interdisciplinary “huddles” with delegated Provider Group leadership. Promotes compliance with and adheres to all regulatory and quality standards including but not limited to: Centers for Medicare and Medicaid Services (CMS), Department of Managed Health Care (DMHC), Department of Health Care Services (DHCS), and accreditation bodies’ standards such as the National Committee for Quality Assurance (NCQA) as it relates to care management activities, including requirements for Special Needs Plans.
Supports the development of programs and initiatives to support members with chronic conditions, complex social needs, behavioral health needs, and end-of-life or advance care planning needs; provides oversight of vendors as needed. Maintains professional and technical knowledge by attending educational workshops, reviewing professional publications, establishing personal networks, participating in professional societies.
All other duties as assigned.
Your Qualifications
Bachelor's Degree or equivalent experience
CA RN strongly preferred
5+ years leading teams/management experience.
Medicare/Medi-Cal experience in managed care environment.
5+ years of management experience in a medical group, IPA, and/or HMO setting, preferred.
3–5 years clinical experience with geriatric population (Acute, Ambulatory Care, SNF and/or LTC), preferred.
Health insurance industry experience, preferred.
Leadership - Skilled to develops others
Business Insight - In-Depth understanding of the business
Problem Solving - Good problem-solving skills
Strategic Mindset - Creates strategies to sustain competitive advantage
Knowledge of California managed care industry, preferred.
Self-starter who can initiate and lead projects as well as navigate different environments.
Strong analytic, quantitative, and problem-solving skills.
Strong verbal and written communication skills.
Strong presentation skills and ability to appropriately and effectively address diverse environments.
What's in it for you?
Base salary range: $125,400 to $200,600 per year Remote Work Mode Internal Job Title: Director, Clinical Ops An annual employee bonus program Robust Wellness Program Generous paid-time-off (PTO) Eleven paid holidays per year, plus 1 floating holiday, plus 1 birthday holiday Excellent 401(k) Retirement Saving Plan with employer match and contribution Robust employee recognition program Tuition reimbursement An opportunity to become part of a team that makes a difference to our members and our community every day-
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