Director Care Management, Medicaid
7 months ago
Seattle
Job Description This position is a hybrid remote from home and travel position. Travel across the state to meet with community partners and to the main office may be required. Candidates from all areas of Washington state are welcome to apply. Who we are Community Health Plan of Washington is an equal opportunity employer committed to a diverse and inclusive workforce. All qualified applicants will receive consideration for employment without regard to any actual or perceived protected characteristic or other unlawful consideration. Our commitment is to: • Strive to apply an equity lens to all our work., • Reduce health disparities. Responsible for the direction and coordination of care management activities to manage the care of the member over the continuum of care, including both physical and behavioral health services, for assigned lines of business. These activities include proactive identification of members in need of care management services, application of case management for identified members, care coordination and condition-specific management for certain populations with an emphasis on equity. The focus is on supporting access to medically necessary and high quality of care and efficient utilization of available healthcare resources, facilities and services and collaboration with community programs and agencies for effective utilization of social services in the community. This role encompasses the effective and efficient management of human, fiscal and other resources, development of staff competency through assessment and education, compliance with regulatory and professional standards and strategic planning, improvement of quality, service levels, safety, customer satisfaction and of collaborative relationships within CHPW and CHNW. To be successful in this role, you: • Have a bachelor’s degree in Nursing or a master’s degree in social work and/or a relevant health field, required, • Have a master’s degree in Nursing, Healthcare Administration, Public Health, or Business strongly preferred, • Have a current, unrestricted license in the State of Washington as an RN required, if applicable, • Have a current, unrestricted license in the State of Washington as a Social Worker (LSWAA, LSWAIC) required, if applicable, • Have a certification as a Case Manager, required, • As this position involves traveling on behalf of the Company, a current driver’s license and an acceptable driving record is required, • Designs and implements systematic and comprehensive care management policies and procedures that ensure high quality care management application to positively impact member outcomes., • Administers and ensures care management programs meet compliance and regulatory standards as required by Centers for Medicare & Medicaid Services (CMS), DSNP Model of Care (MOC), Washington Health Care Authority (HCA), and/or National Committee on Quality Assurance (NCQA) for continued accreditation of the health plan, as well as state and federal regulations, quality metrics and evolving models of care., • Provides oversight of programs within assigned lines of business including development, implementation of program components, quality data collection and monitoring, auditing of program requirements and reporting outcomes to appropriate leadership and committees., • Responsible for a strong understanding of health plan benefits for all lines of business., • Defines strategy to identify and assess outlying and high-risk cases to determine plan of care., • Develops and designs procedures, processes, productivity targets, quality of care and financial goals, and new delivery models for medical and behavioral health care management., • Collaborates with Medical Directors, Healthcare Analytics, Network Management and other departments as needed to collect, analyze, and report on effectiveness of programs and address quality of care issues. Uses data to guide the development and implementation of health care interventions that improve value to the member., • Collaborates with internal leaders to deploy a coordinated regional approach to member and provider services in each region across the state., • Drives strategy for the development, reporting, monitoring, and analysis of department measures that are linked to organizational goals especially as pertains to achieving enrollment targets in care management programs and return on investment projections on care management programs., • Works collaboratively with other members of the Clinical Services Leadership Team to establish mechanisms and processes to regularly analyze the different Plan populations for variances in clinical and service quality to identify and recommend the highest impact opportunities and department-level strategies for interventions., • Delegates responsibilities to managers and provides professional development opportunities for team leaders., • Provides leadership in developing, implementing, and communicating short and long-range plans, goals, and objectives for clinical teams. Aligns team goals with the organization’s vision and strategy., • Evaluates and integrates Community Health Center processes and programs to ensure that resources are being maximized to improve member care and reduce duplication of work within CHPW., • Responsible for ensuring the day-to-day supervision of divisional staff including identifying staffing and resource needs, effective hiring, appropriate performance management, staff development, with the goal of developing a cohesive, empowered, and productive work environment., • Responsible for annual budget preparation and monitoring expenses within the department., • Participates and/or Chairs/Co-Chairs on committees as assigned, • Employees are expected to report to work as scheduled, participate in all assigned meetings, and meet established performance and accountability standards., • Experience with designing and deploying new programs and teams., • Demonstrated ability to effectively lead and manage large staffs, including the ability to achieve results through others., • Experience with identifying, testing and implementing innovative concepts that support special population needs., • Knowledge of the various components of managed care (quality improvement, disease management, population management, utilization management, and case management) and how they link., • Actively uses and supports quality improvement principles and methods in an effort to improve inter- and intra-departmental processes., • Strong project management skills, including the ability to implement new programs and products., • Excellent ‘customer service’ attitude in relationships with enrollees/patients, staff and external partners., • Highly effective communicator orally and in writing, with the ability to translate strategy into action., • Fosters an effective work environment and ensures employees receive recognition, feedback and development., • Ability to relate and interact with staff at all levels of the organization; exercises sound judgment, builds strong working relationships and demonstrates diplomacy, professionalism, and appropriate confidentiality in dealing with others., • Strong analytical and problem-solving skills., • Articulates organizational vision and implements strategic initiatives, with the ability to identify systemic issues to promote real change., • Working knowledge of M/S office (Word, Excel, Access), • Knowledge of regulatory and certification requirements and their impact on the organization (for example, HEDIS, CAHPS, and NCQA). As part of our hiring process, the following criteria must be met: • Has not been sanctioned or excluded from participation in federal or state healthcare programs by a federal or state law enforcement, regulatory, or licensing agency., • Vaccination requirement (CHPW offers a process for medical or religious exemptions) The position is FLSA Exempt and is not eligible for overtime. Based on market data, this position grade is 72 and has a 15% annual incentive target based on company, department, and individual performance goals. The base pay actually offered will take into account internal equity and also may vary depending on the candidate’s job-related knowledge, skills, and experience among other factors. The targeted starting salary range for this position is between $145,000.00 - $165,000.00 annually. CHPW offers the following benefits for Full and Part-time employees and their dependents: • Medical, Prescription, Dental, and Vision, • Telehealth app, • Flexible Spending Accounts, Health Savings Accounts, • Basic Life AD&D, Short and Long-Term Disability, • Voluntary Life, Critical Care, and Long-Term Care Insurance, • 401(k) Retirement and generous employer match, • Employee Assistance Program and Mental Fitness app, • Financial Coaching, Identity Theft Protection, • Time off including PTO accrual starting at 17 days per year., • 40 hours Community Service volunteer time, • 10 standard holidays, 2 floating holidays Sensory*: • Extended periods of sitting, computer use, talking and possibly standing, • Simple grasp, firm grasp, fine manipulation, pinch, finger dexterity, supination/pronation, wrist flexion, • Frequent torso/back static position; occasional stooping, bending, and twisting. Office environment Employees who frequently work in front of computer monitors are at risk for environmental exposure to low-grade radiation.
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