Director of Care Management

Company: Optum
Location: Tacoma
Posted on: January 14, 2021

Job Description:

Director of Care ManagementIn support of NPN's mission, vision, and strategic goals, the Director of Care Management leads the Clinical Care Management team. This position is responsible for developing, implementing, refining, maintaining and execution of Care Management services, programs, products and product lines for Optum Care Network. Responsibilities include the functional areas of Care Management, Disease Management and Transitions. --The Director of Care Management oversees clinical focused applications and systems including implementation, ongoing maintenance, support, enhancement and education to clinical staff and for assessing current and future technology needs for clinical staff and the impact of the technology on assigned processes.ESSENTIAL DUTIES & RESPONSIBILITIES

• Provides effective administration and operational team leadership of the care management program including strategic planning, project management and fiscal management
• Coordinates and communicates care management objectives with contracted providers/affiliates and ancillary vendors.
• Keeps leadership advised on current events which may affect Optum Care Network as a whole
• Evaluates financial and care trends concurrently and retrospectively and implements plans to improve resource utilization, outcomes and reduce financial burden
• Oversees the development, implementation and review of policies and procedures (including desk manuals) based on local, state, federal, contract and NCQA standards
• Responsible for health plan delegation, contract compliance and audits related to Care Management
• Analyzes departmental data and recommends system or workflow improvements when appropriate
• Triages departmental system issues and involves appropriate staff and departments on problem resolution
• Leads clinical focused system installations and enhancements
• Ensures adherence to policies, procedures and regulations
• Directs activities to implement and manage clinical quality improvement initiatives related to utilization/affordability
• Manages and maintains staffing within budget
• Responds to issues and concerns escalated from staff or Executive Team
• Prepare and present all relevant clinical data to UM/QM committee and Optum Care Network leadership team to comply with health plan delegation requirements
• Prepare and present ongoing education to the care management staff in compliance with health plan delegation requirements
• Responsible for the care management staff employment life cycle
• Maintains confidentiality of patient and all related entity business matters of the organization and its partnersKNOWLEDGE, SKILLS AND ABILITIES
  • Keeps current on all NCQA, local, state and federal health care regulations, incorporates changes in regulations to ensure compliance by staff
  • Working knowledge of:
    • Case, Disease, and Care Management services----------------
    • Health care delivery system
    • InterQual/Milliman criteria guidelines
    • Medicare/Medicaid commercial payor guidelines------------------------------------------------------------------------------------
    • Demonstrated knowledge of PC applications including MS Office Suite
    • Skill in writing clear, grammatically correct, easy-to-use instructional documentation
    • Ability to analyze complex problems and formulate plans, solutions and courses of actions
    • Knowledge of specific communication needs with the ability to listen actively and respond to internal and external customers in a timely, competent manner both verbally and in writing
    • Demonstrated skill in learning and fully utilizing information technology systems-------------- ----------------------------------
    • Ability to work accurately with detail----------------------------------------------------------------------------------------------------------------------------------------------
    • Knowledge of technical resources within the organization for needed information
    • Ability to judge appropriate information to be conveyed to different levels of management------------------------------------------
    • Skill in working with a team; collaborating with colleagues------------------------------------------------------
    • Ability to establish and maintain cooperative working relationships with individuals at all levels of the organization
    • Skill in working effectively under deadlines, frequent interruptions and changing prioritiesMINIMUM QUALIFICATIONSEducation: Degree in Nursing (RN) BSN PreferredExperience:
      • 5 years broad based clinical experience
      • 5 years management experience of professional and technical staff
      • 5 years nursing leadership experience in developing Care Management functionsCertification/License:--
        • Current unrestricted RN License in the State of Washington
        • Current driver's license

Keywords: Optum, Tacoma , Director of Care Management, Executive , Tacoma, Washington