Senior Director-Care Management Operations (Hybrid, Primarily Remote) North Carolina

  • Alliance Health
  • Sep 09, 2022
Full time Health Care

Job Description

Submit Application and Resume to Alliance Health at https://www.alliancehealthplan.org

Reference Requisition SENIO001850

Alliance is currently seeking candidates for the role of Sr. Director, Care Management Operations. One Director will be based out of our Home Office in Morrisville NC and one in Charlotte NC. The Directors will oversee the smooth and efficient operation of Alliance’s Care Management department (CM) as directed by the SVP-Care Management and Population Health.  Core responsibilities shall include: oversight of all Care Management, Transition to Community Living (TCLI), Traumatic Brain Injury (TBI) and Medicaid C waiver programs. Receiving strategic direction from the SVP-Care Management and Population health, the incumbent will assist with the management of new and existing department initiatives across the Alliance catchment areas.

The Senior Director of Care Management Operations is responsible for leading the development and overseeing the execution of policies and procedures and directing the standardization of policies, practices workflows and data reporting within the system.  The incumbent will manage key performance indicators and provide education/drive towards improvement to ensure quality patient care and adherence to all relevant compliance activities.

This position will allow the successful candidate to work a flexible schedule with onsite being required 1-2 days a week a week as approved by their supervisor. 

Responsibilities & Duties

Oversee Department operations 

  • Receiving strategic direction from the SVP-Care Management and Population Health, the Senior Director will assist with the management of new and existing department initiatives across all units in the Alliance catchment areas
  • Collaborate and coordinate with the medical team to ensure the delivery of effective, efficient, integrated and evidenced based services and interventions.  
  • With consultation from the SVP-Care Management and Population Health, ensure staff  in all of the Alliance catchment area are well trained in the use of Alliance clinical decision-making tools and practice guidelines
  • Accountable for the training and development of the Care Management department in collaboration with the Organizational, Learning and Development team, overseeing all training activities of the Care Management Support team  
  • Lead the department in the creation of training programs and materials. This role demands the ability to work collaboratively as well as independently, while handling multiple projects
  • Oversee development of all training materials/workflows related to updated information or contractual requirements for all programmatic CM areas from the following: (NC State agencies, NC regulatory bodies, NC Contract, NCQA, HEDIS, & CM best practices), etc. 
  • Review data for trends and analyze the impact on department operations. 
  • Lead the implementation of improved clinical care management models to decrease readmissions, Emergency (ER) utilization, recidivism, and excessive length of stay; 
  • Responds to  regulatory changes by education and leading the development of all policy/procedure changes relevant to the change
  • Create and maintain spreadsheets and other relevant care management reports including, but not limited to, staffing, caseload, productivity, cm dashboards, Tailored plan, and auditing
  • Train management, staff, and stakeholders on how to use and create reports for Care Management oversight and monitoring activities, programs, Tailored Plan initiatives, etc.
  • Provide relevant, timely feedback to SVP-Care Management and Population Health regarding any adverse reporting results

Manage and Develop Staff

  • Work with Human Resources and SVP-Care Management and Population Health to maintain and retain a highly qualified and well-trained workforce 
  • Ensure staff are well trained in and comply with all organization and department policies, procedures, and business processes
  • Organize workflows and ensure staff understand their roles and responsibilities
  • Ensure the department has the needed tools and resources to achieve organizational goals and to support employees and ensure compliance with licensure, regulatory, and accreditation requirements
  • Actively establish and promote a positive, diverse, and inclusive working environment that builds trust
  • Ensure all staff are treated with respect and dignity
  • Ensure standards are transparent and applied consistently, impartially, and ethically over time and across all staff members
  • Work to resolve conflicts and disputes, ensuring that all participants are given a voice
  • Set goals for performance and deadlines in line with departmental and organization goals and vision
  • Effectively communicate feedback and provide ongoing coaching and mentoring to staff and support a learning environment to advance team skills and professional development
  • Cultivate and encourage efforts to expand cross-team collaboration and partnership

Ensure Intradepartmental cooperation

  • Collaborate and coordinate with the Chief Medical Officer, Executive Vice President/Chief Operating Officer, and Senior Vice President of Community Health to ensure effective operations of the division, support of organized care teams that deliver interventions and support under the care management model, and ensure intra-departmental cooperation on cross department initiatives
  • Collaborate with Alliance IT teams to develop recurring or one-time departmental reports, as needed.

Develop and implement department policies, procedures, process, and workflows

  • Assist with writing and editing of new and existing policies, procedures, and workflows related to operation of the Care Management department and care management initiatives across the organization

Communicate and report 

  • Communicate and report effectively to Leadership at Alliance, to providers, to the community, to all staff and stakeholders as needed about service trends, identified gaps and needs, recommended implementation of new processes, practices and effectiveness of clinical model
  • Foster and promote two-way communication and information sharing for successful program implementation and maintenance
  • Lead the development of effective communication with internal and external customers to coordinate and adequately address patient care needs
  • Provide accurate and pertinent information to appropriate departments, administration, medical staff, and others involved with CM activities

Ensure Compliance Standards are met

  • Work with Alliance’s Legal, Compliance, and Operations Division to ensure the department operates in compliance with NC State Agencies, CMS, EQR, and NCQA procedures, proactively identifies agency risk and implements corrective action when needed

Assist with development and management of Department budget

  • Remain cognizant of current Alliance and departmental spending trends and the effect on the availability of fiscal resources; discuss budget requirements and amendments with SVP-Care Management and Population Health ,as well as the Chief Medical Officer

Review and respond to Member Care Issues/Incidents

  • Recognize and respond to member care issues providing direction, feedback, and follow-up to staff or other healthcare team members.
  • Escalate/Communicate any risk, high profile, member issues to CMO and SVP immediately-ensuring timely communication

Minimum Education & Experience

Bachelor’s degree in Nursing with RN license and seven (7) years of experience with the population served, including two (2) years of direct, progressive experience managing clinical and non-clinical resources/business areas. Health Plan Managed Care experience highly preferred. 

Or

Masters degree in Psychology, Social Work, Counseling, or related field and five (5) years of experience in mental health, substance abuse and/or developmental disabilities, including two (2) years of direct, progressive experience managing clinical and non-clinical resources/business areas. Requires experience leading and managing a broad and diverse business operation. Health Plan Managed Care experience highly preferred.

Special Requirement

Clinical License (RN, LCSW, LCMHC, LPA, or LMFT) and Drivers License 

Knowledge, Skills, & Abilities

  • Thorough knowledge of clinical management measures
  • Thorough knowledge of systems management
  • Thorough knowledge of strategic plan development
  • Thorough knowledge of program evaluation
  • Thorough knowledge of quality improvement processes
  • Thorough knowledge of outreach strategies
  • Knowledge of work culture enhancement
  • Excellent customer service skills
  • Excellent leadership skills
  • Conflict resolution skills
  • Ability to multi-task and work in a fast-paced environment with changing priorities
  • Ability to communicate effectively
  • Ability to build consensus
  • Experience with and ability to manage key performance indicators
  • Ability to develop trust, cooperation, and collaboration with administrative medical staff and departments across the system
  • Ability to create consistent/standard work. 

Salary Range 

$83,249.92 to $143,312.59/Annually 

 

Occupations

General-Other: Medical-Health

Salary

$83,249.92 to $143,312.59/Annually