Director of Care Management
Job Opportunity at Surf Search

Posted on Jul 25    858-876.8801

Location: Kalamazoo, MI
Job Type: Full Time
Job ID: W4138585

Director of Care Management - Managed Care

Rapidly growing integrated healthcare provider seeks a Director of Care Management  to support and guide system-wide care center and care management functions.  The Director of Clinical Operations will support and manage project implementation activities, change project activities and implement best practices, policies and processes throughout the entire organization.  The Director of Clinical Operations will:
  • Develop and execute care management implementation activities for new markets, new market service areas and new plan partners
  • Develop and maintain collaborative relationships with other internal market leaders, payor partners and corporate teams
  • Act as Care Management leader during implementation processes in new markets, then assist in identifying and hiring permanent site leadership
  • Oversees risk stratification guidelines compliance through reviews of care management activities and systems reporting
  • Support achievement of cost, quality and patient/member experience goals
  • Lead care management and social work teams ensuring local market leadership in quality, efficiency, and performance
  • Direct, plan and evaluate care management documentation quality through independent reviews and through the monitoring of the internal quality review tools
  • Develop care management policies, procedures or other job aides as needed
  • During market expansion, monitor care management clinical operations as well as contractual and regulatory operational requirements during implementation and post-implementation to drive compliance and operational efficiencies
  • Monitors staffing and budget for care management
  • Supports and oversees care management acuity assignment methodology
  • Support new technology development by defining business specs/requirements for clinical operations
  • Oversees risk stratification guidelines compliance through reviews of care management activities and systems reporting

  • R.N. and Bachelor's degree, advanced degree preferred
  • 3+ years experience in health plan care management required.
  • Administrative experience with MMP - Medicare-Medicaid Plan,  and/or D-SNP - Dual Eligible Special Needs Plans - programs required. This could include experience with MI Health Link or other dual eligible programs
  • Healthcare provider experience preferred
  • Experience with CMS program audits
  • Ability to travel up to 30%
  • Strong communications, interpersonal and critical-thinking skills
  • A track record of accomplishment in working with a diverse patient population, workforce and cross functional provider networks

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