Director of Integrated Care Management (Medicare)

Scope of Role & Responsibilities

• Participates in the development of the vision and strategic direction for Integrated Care Management
• Collaborates on the implementation of related strategies
• Supervises, plans, organizes, prioritizes, delegates, and evaluates staff and functions of the Integrated Care Management Department and Medicare line of business
• Ensures staff are care managing members in accordance with the risk stratification identified and adhering to the care management process of screening, assessing, implementing, and evaluating
• Participates in development, implementation, and annual review of the Integrated Care Management and Quality Management/Quality Improvement Plan
• Provides oversight for the implementation and adherence to the Model of Care
• Ensures compliance with Federal, State and City regulations as they relate to Medicare, Medicaid, and Health Homes
• Provides oversight for Transitions of Care Process and tracking, implementing strategies to prevent readmissions and reduce hospitalizations
• Collaborates with NYC H+H and external partners on various initiatives, projects and pilot programs
• Gathers, develops and tracks data on evidence-based practice interventions
• Represents ICM at various meetings and committees as required
• Provides clinical support for the review of Quality-of-Care concerns being investigated by the Quality Management Department, and collaborates with Quality Management on HEDIS, STAR ratings and CAHPS score improvement initiatives and strategies
• Collaborates with the UM Department to manage appropriate member utilization and works with data analytics to generate reports that will illustrate the impact on members' utilization
• Drives the implementation of processes and functional enhancements which will improve the overall quality and services provided by the CM teams
• Collaborate with MetroPlusHealth customer service department to ensure that member issues and concerns are addressed and resolved in a timely manner
• Analyzes trends and implements departmental initiatives based upon data provided through the reporting of Care Management or from Quality, Data Analytics and Audit data
• Ensures comprehensive and supportive on-boarding of new hires and effective, data-driven monitoring/coaching to ensure that efficiency and performance are maximized among existing staff
• Maintains communication with the department head, offering routine updates on operations, issues, concerns, and other pertinent information
• Performs other duties as assigned by the Senior Director

Required Education, Training & Professional Experience

• Bachelor of Science in Nursing required
• Master’s Degree in Nursing preferred
• Minimum 10 years professional healthcare management
• Minimum 5 years in leadership role, Manager and above
• A minimum of 5 years of administrative experience with supervision of clinical and ancillary staff in a Managed care role required
• Must be familiar with OMH, DOH, CMS regulations for service delivery, with a care coordination approach to service delivery in managed care settings

Licenses & Certifications

• Valid New York State license and current registration to practice as a Registered Professional Nurse (RN) issued by the New York State Education Department (NYSED)

Professional Competencies

• Integrity and Trust
• Leadership and Management Skills
• Customer Focus
• Functional / Technical skills
• Written/ Oral Communication
• Ability to successfully multi-task while under strict timetable
• Exceptional Organizational skills