Dir Care Management

Job ID: J115377
Company: Gateway Health Plan
Location: Wilmington, DE, United States
Full/Part Time: Full time
Job Type: Regular
Posted at:

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Description

I.    GENERAL OVERVIEW:  
This section contains a synopsis of the main purpose(s) or functions(s) of the job, indicating what is done.  This information will be used to develop the position posting. 
Director of Care Management will develop and ensure execution of the strategic and operational plans for care management and special needs program development, delivery and evaluation.  Accountable for all aspects related to care delivery, member outcomes, and financial performance goals.  Provides leadership to support effective care management processes and programs for members with complex medical, behavioral and psychosocial needs.  Special attention is given to those identified as high profile or sensitive by internal sources, DPW, CMS, or other external entities.  Oversees development, implementation and evaluation of Disease Management and Preventative Health Programs and outreach/interventions with members.  Ensures collaboration with program development, care management and external agencies to identify member need and develop program content related to clinical or psychosocial conditions/risk factors.  Establishes and monitors goals, benchmarks, and work plans for projects to ensure consistency with corporate and departmental objectives and measurable outcomes.  Develops and implements annual department budget and staffing plans.  
II.    ESSENTIAL RESPONSIBILITIES:  
This section lists the major duties and responsibilities of the position.  This is not an exhaustive list of all job duties/functions/attributes.  Depending on Role, essential responsibilities may also include oversight and management of people and functions described below.
1.    Directs all management activities for Care Management Departments.

  • Ensures staff compliance with internal and external regulatory requirements and profession practice standards.  
  •  Recruits and approves hiring of staff; performance management; coaching, training and resource planning of staff; ensures departmental staffing supports the corporate standards.

2.    Develops, gains approval for and implements strategic plan and annual operating plan.  Monitors all aspects of the care management process, including but not limited to, assessment, care plan development, interventions, and quality management.  
3.    Ensure implementation and measurement of care management performance standards. Develops and implements policies, procedures and trainings to ensure compliance and effective service/program delivery.  
4.    Identifies, develops and implements process improvements which are focused on quality, utilization, cost containment and outcomes.  
5.    Oversees and approves research and development of programs that improve clinical outcomes and member satisfaction.  Ensure appropriate and cost effective utilization of health care resources, including the integration and evaluation of quality of care measures.
6.    Accountable for outreach delivery and measurement of impact.  Ensures new and existing program review evaluation.  
7.    Develops and implements annual department budget and staffing plan.  
8.    Other duties as assigned or requested.

III. QUALIFICATIONS:
Education, Licenses/Certifications, and Experience (For Experience requirements please see appropriate role/level guide.  If not applicable, list experience requirements below.)

Describe in objective and non-comparative terms the minimum education level, previous experience, specific knowledge skills and abilities the individual must have to perform the job.    

Minimum

  • Bachelor’s degree in Business or health related field OR 7-10 years care/case management experience
  • 5 years’ experience in managed care, specifically in case management, utilization management and/or discharge planning
  • 5 years pervious supervisory/management experience
  • Commonwealth of PA license in appropriate clinical discipline (RN or LSW or other related discipline)        

Preferred

  • Master’s degree
  • CCM 

IV. SCOPE OF RESPONSIBILITY  (People Management Responsibility)
Does this role supervise/manage other employees?          No  □     Yes   x         
If yes, indicate the number of direct reports:  


V. WORK ENVIRONMENT
Most company positions are performed in a normal office environment.   Please use this section to describe unusual work conditions, such as exposure to high noise levels, temperature extremes, etc.  If “none, “please indicate with “Not Applicable.”
Is Travel Required?
No   □    Yes   x          
Unusual Working  Conditions

Physical Demands
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

This job requires the ability to work as a team member.  Additionally, this job requires the willingness and ability to report to work on a regular and timely basis and may require irregular work hours, holidays and/or weekends.
 

Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities, and prohibit discrimination against all individuals based on their race, color, religion, sex, national origin, sexual orientation/gender identity or any other category protected by applicable federal, state or local law. Highmark Health and its affiliates take affirmative action to employ and advance in employment individuals without regard to race, color, religion, sex, national origin, sexual orientation/gender identity, protected veteran status or disability.
EEO is The Law
Equal Opportunity Employer Minorities/Women/ProtectedVeterans/Disabled/Sexual Orientation/Gender Identity (http://www1.eeoc.gov/employers/upload/eeoc_self_print_poster.pdf)
We endeavor to make this site accessible to any and all users. If you would like to contact us regarding the accessibility of our website or need assistance completing the application process, please contact number below.
For accommodation requests, please call HR Services at 844-242-HR4U or visit HR Services Online at HRServices@highmarkhealth.org

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