The Corporate Director Care Management is responsible for developing and implementing workflows, processes and strategies to facilitate the coordination of the company’s care management needs. Provides leadership, direction and support for the efficient and smooth coordination of patients, member and provider needs with needed resources throughout the organization. Achieves quality outcomes, reduces costs, and shapes and interprets the standards required to ensure a high degree of patient, physician and employee and member satisfaction.. The Director will oversee day to day care management programs necessary for BSHSI and GoodHelp ACO to become successful in delivering differentiated population health services.
The position reports jointly to the SVP and Chief Nursing Officer and the Chief Executive Office of GoodHelp ACO. He/She will work very closely with the Corporate Clinical Director of Population Health. They will oversee, in conjunction with the local system Directors of Population Health, the day to day operations of our care management programs.
Guides the development and implementation of short and long-range goals and objectives for system-wide health management programs. Provides leadership and expertise in the development, implementation, oversight, and evaluation of the system’s core health management programs and practices. Incorporates best practices and responds to emerging trends to enhance operations, programs, and/or services. Implements and evaluates strategic programs, develops effective tools to measure performance, analyzes related data, prepares reports, and makes recommendations to senior leadership based on findings
Oversees and/or directs the development and implementation of company-wide care coordination, utilization management, and social work services policies, and procedures in conjunction with related goals and objectives. Ensures compliance with federal and state regulations, as well as established organizational policies and procedures.
Establishes and oversees the development and implementation of case management services short and long-range goals and objectives and determines the optimal progression to obtain these goals. Reviews analyses and reports of various activities to determine department progress toward stated goals and objectives.
Directs and participates in the development, implementation, and consistent application of effective organizational policies, procedures, and practices. Develops and supports internal controls to ensure that assets are safeguarded, policies and operating procedures are followed, necessary controls are effective and efficient, and compliance with current laws and regulations is achieved.
Expert level clinical knowledge in the area of care management principles as they relate to population health.
Required, 5-7 years experience with a health care delivery system or managed care entity, preferably in a risk or gain sharing reimbursement model.
Required, 3-5 years experience overseeing a successful care management program operation within a collaborative managed care or large delivery system environment.
Required, demonstrated success in improving the health of a distinct population of patients in the ambulatory or community setting.
The executive presence to work with delivery system Chief Medical Officers and other “C level” executives.
An understanding of the complex ways in which health systems operate and experience with implementation of change management at integrated delivery networks.
Demonstrated appreciation of cultural diversity and sensitivity towards target populations.
EDUCATION AND CERTIFICATION REQUIREMENTS
RN licensure required; BSN preferred
Master’s degree preferred.
Sound clinical knowledge and recognized as a credible clinical resource.
General knowledge of the health benefits business, clinical issues, trends and medical management, medical care delivery systems, utilization management, quality management, contracting, benefits interpretation, provider relations and customer service.
Interpersonal and listening skills that bring out the best in medical management colleagues.
Ability to build a high performing team by promoting a culture of energy and commitment, mentoring employees and supporting ongoing training and development of staff.
Ability to successfully operate in a highly matrixed and changing environment.
Effective and skilled public speaker and presenter.
Ability to implement complex program and monitor implementation and modifications.
Ability to manage multiple priorities and deadline in an expedient and decisive manner.
Questions processes and suggests improvements to create market-leading innovation in ACO clinical program design.
Bon Secours Health System is a $3.3 billion not-for-profit Catholic health system sponsored by Bon Secours Ministries. Headquartered in Marriottsville, Maryland, the system owns, manages, or joint ventures 19 acute-care hospitals, one psychiatric hospital, five nursing care facilities, four assisted living facilities, and 14 home care and hospice services.
More than 22,000 Bon Secours employe...es help people in six states, primarily on the East Coast. Bon Secours Health System offers competitive compensation, robust benefits package in a progressive environment. Serving is our passion. Consider joining our world class ministry www.bshsi.org.