Director, Care Management - REMOTE

Summary of Position

Assist in leading the strategic development of analytics and business intelligence to support population health and market growth initiatives. Collaborate with the AVP, Care management and ACPNY leadership on, and operationalize, CM strategic plan.Works Collaboratively with ACPNY partners to prevent avoidable emergent care visits and re-hospitalizations. Responsible for selection and hiring of qualified staff, ensuring an effective on-boarding and provides ongoing comprehensive training and regular feedback. Responsible for the day to day operation and performance, in collaboration with the APNY team, AVP of Care Management and Field Based Care Managers providing services to EmblemHealth members at the ACPNY location sites. Visit field sites and build relationships with ACPNY colleagues and EH Care Management staff. Provide education, coaching, and mentoring to team members to address performance related issues. Use problem solving abilities to create solutions to operational and clinical issues identified during day to day operations. Serve as an essential link between the Plan's staff and its internal and external customers to promote and improve communication of initiatives relative to Care Management. Address audit related findings and implement performance improvement strategies. Collaborate with other functional areas within organization to ensure that care managers are implementing EmblemHealth Health Plans policies, procedures and all regulatory mandates, consistent with EmblemHealth plan's mission, vision, purpose and value statement. Responsible for data collection needed to report on program metrics. Responsible for oversight of HEDIS/STARS and NCQA requirement responsibilities of the Care Management team to support Organizational deliverables.

Principal Accountabilities

• Manage daily operations of the Care Management team (Managers and Care management team): define metrics; measure performance and productivity against standards; deploy strategies to improve performance.
• Train employees in process operations; act as a preceptor to newly hired staff.
• Complete quarterly evaluations of staff as needed.
• Monitor team caseloads; shift workloads accordingly to meet departmental/organizational needs.
• Monitor timeliness and appropriateness of documentation in clinical systems to ensure that accreditation and regulatory standards are met.
• Ensure that team members are managing enrollees across the care continuum inclusive of behavioral health so that enrollees have access to needed care and services.
• Serve as a clinical resource; attend Care Management rounds.
• Monitor employees' performance regularly and coach employees as needed.