SENIOR DIRECTOR CARE MANAGEMENT

Responsibilities: Develop and deploy a member-centric care program strategy Lead the development of innovative care management models to support affordability and future operating platform strategy Lead the transformation of the current telephonic case management program to a mix of high touch and low touch solutions ranging from face to face to virtual engagement solutions Leverage the best practices of the current state to evolve in to a scalable model that addresses the needs of the future provider models (including ACO, Integrated Health Systems PCMHs) Customize solutions that are aligned with regional practice patterns and delivery system needs and provide appropriate monitoring evaluation and controllership to ensure desired business results are met Develop effective business processes to address the to address the high opportunity impactable members/population segments, disease states, episodes and delivery system solutions necessary to support Care Programs long-term strategy Develop effective Medicare Care Management Strategy to improve outcomes, mitigate cost trends and improve STAR ratings Effectively integrate care programs across the care continuum Align the Clinical Operations along the quality and administrative continuums to define MLR vs. non-MLR operations spend Lead the development and improvement of Care Program processes and performance standards Lead, develop, motivate and manage a high performing team to meet organizational goals and objectives while effectively managing change Lead the development of policies, procedures, standards and training Coordinate with Member Service Organization (MSO), Retail Health, Senior Business Unit and other matrix partners to seamlessly integrate member empowerment and engagement programs Lead the development of vendor management strategy to support Care Programs Ensure that the Care Program processes are aligned with the highest quality standards required by – Accreditation and Credentialing Organizations (for example, NCQA, URAC, etc.) Interpret financial data and trends to guide and evaluate business decisions JOB REQUIREMENTS Current RN license with Bachelors degree in healthcare management or related field; advanced degree preferred 7+ years experience in healthcare administration with progressively increasing leadership and operations positions in a large health plan Case Management and Disease Management experience Demonstrated capability in development execution of strategic initiatives Demonstrated track record of improving care outcomes Demonstrated capability in setting and delivering program goals Strong verbal and written communication skills For additional information and/or confidential consideration, please contact: CONSULTANT: Tricia French, RN, BSN President & CEO The French Group 757-362-0202 tfrench@frenchgroup.com