Director of Care Management

Job Description

Job Description

Description:

JOB SUMMARY

The Director is responsible for improving the health status of designated high risk / rising risk individuals to reduce their risk stratification score and promotes value in the utilization of health care resources. The Director is responsible for utilization management across the care continuum to reduce overall panel PMPM cost across the following categories: hospital, emergency department, outside provider/specialist and pharmacy. The Director conducts ongoing analysis and reports significant utilization trends, patterns, and impacts to resources.

Requirements:

DUTIES AND RESPONSIBILITIES

• Manages and monitors care plans and timely completion of goals to ensure that the patient is receiving the right care in a timely and cost-effective manner in order to obtain optimum value for patient, payer and provider.

• Conducts ongoing, time framed, manual or electronically generated audits based on defined standards and indicators.

• Provides clinical expertise related to information technology for clinical services including assessment, evaluation, and education related to clinical initiatives in order to incorporate evidenced-based care into clinical practice.

• Participates in the development of protocols, policies, quality metrics and best practices as it pertains to population health management, to assure compliance with regulations, improved workflows and effective utilization reviews.

• Assigns registry of high need individuals to care managers.

• Provides ongoing training to Care Managers, to include care planning, care transitions and resource management, while promoting quality and cost-effective interventions and outcomes.

• Manages productivity and effectiveness of Care Managers.

• Understands and upholds CentroMed’s mission and values relating to ethics, integrity, safety, corporate responsibility and objectives

• Actively participates in maintaining high levels of excellent customer service internally and externally

• Abides by all policies and procedures set forth by CentroMed

• Ensure the protection and security of a consumer’s personal, confidential and identifiable information in a professional and responsible manner and carry out all measures to prevent from unauthorized disclosures. Demonstrating and maintaining the standards and requirements of the Health Insurance Portability and Accountability Act (HIPAA).

• Assists in training new employees in performing their duties as requested

• Performs all duties in conformance to appropriate safety and security standards

• Participate in the agency’s Quality Improvement Program

• Performs other duties as assigned

• Work must be performed on-site as designated

QUALIFICATIONS

Education Graduation from an accredited school of Nursing

Must maintain current licensure (LVN or RN) with the Texas Board of Nurse Examiners.

Master’s Degree in Health Information Management, Public Health or other health related degree preferred.

Knowledge of public health and primary care policy and practice preferred.

Experience in Informatics and/or data analytics preferred.

Experience with MS Office and practice management and electronic health record applications.

Ability to translate technical concepts and data into practical recommendations and applications.

Other:

Strong written and oral communications skills

Attention to detail, and flexibility.

Bilingual/Bicultural (preferred);

Capable of working well in a diverse team environment

Ability to maintain a professional attitude and demeanor at all times including high pressure situations

Must demonstrate problem solving skills.

PHYSICAL REQUIREMENTS

• Must be able to perform the essential functions of the position.

• Must be able to deliver excellent customer service, externally and internally

• Must be able to meet the attendance requirements of the position.

• Work must be performed at designated on-site location(s)

• Must not pose a threat to the health or safety of other individuals in the workplace.

• Physical ability to lift up to 25 pounds unassisted.