The RequirementsTo meet the basic qualification for this role, you will have legal authorization to work permanently in the United States for any employer without requiring a visa transfer or visa sponsorship. In addition, to be a good fit for the Director of Care Management Operations opportunity, you will have:
- A bachelor's degree from a four-year college or university required, BSN is preferred
- Current / valid Washington State Registered Nurse license.
- 3 to 5 years of management experience in health plan settings, and proven strong leadership skills.
- Experience with D-SNP programs.
- The ability to travel 15% of the time, mostly within the state.
- The ability to work in a Windows-based computing environment.
- Strong interpersonal and critical-thinking skills.
- Flexibility and willingness to roll up your sleeves to achieve goals.
- Strong oral and written communication skills – competency in writing routine reports.
- Confidence when speaking before groups of customers or employees of organization.
- Strong problem-solving skills.
The RoleReporting to the Vice President of Clinical Operations, you will direct the efforts of eight Care Managers (RNs) and four Patient Care Coordinators (CMAs) in our clinics in Renton, Lakewood and Lynnwood. You'll support and manage a team to drive exceptional patient outcomes for a complex patient population using innovative technology solutions in a multidisciplinary care setting.
We'll look to you to achieve exceptional service and meet contract commitments to health plan partners and regulators, and drive project implementation activities and best practice policies and processes. This will include recruiting and training team members serving a diverse membership base.
You'll monitor performance quality and performance metrics while also providing recommendations on operational design and efficiencies. In addition, you will collaborate with other stakeholders and functional areas.
More specifically, your responsibilities will include:
- Developing and executing care management activities to drive compliance with health plan partners’ models of care.
- Creating and maintaining collaborative relationships with other internal market leaders, payer partners, regulators and corporate teams.
- Leading cross-functional clinical and non-clinical meetings and other projects.
- Functioning as market care management leader during implementation as needed to accommodate organic and new product growth.
- Monitoring care management clinical operations as well as contractual and regulatory operational requirements during implementation and post-implementation to drive compliance, quality outcomes and operational efficiencies.
- Acting as care management subject matter expert, understanding and maintaining knowledge of delegated lines of business and community provider relationships.
- Monitoring staffing and budget for care management.
- Supporting and overseeing care management acuity assignment methodology, including supporting new technology development by defining business specifications/requirements for clinical operations.
- Overseeing risk stratification guidelines compliance through reviews of care management activities and systems reporting.
- Identifying and executing best practices for care plan development and management.
- Supporting achievement of cost, quality and patient/member experience goals.
- Leading the care management teams, ensuring they are effectively and efficiently operated, resourced and performance managed by market leadership.
- Directing, planning, and evaluating care management documentation quality through independent reviews and through the monitoring of the internal quality review tool(s).
- Developing care management policies, procedures or other job aides as needed.
- Participating in collaborative meetings between care center staff/providers and care management across all markets, leads clinical operations oversight meetings and maintains agenda and written meeting minutes.
- Developing performance improvement plans or other quality monitoring tools to support performance expectations for all staff.
- Tracking and reporting for supervisors and other market or corporate leadership using systems reports on a defined frequency, taking efforts to validate accuracy and completeness on a regular basis.
- Participating in personnel management including recruiting, hiring, goal setting, evaluations and team building.
- Promoting a positive work environment, sets an atmosphere of open communication and feedback.
- Performing, at a minimum, an annual assessment of operational performance across all key success metrics.
- Handling Other duties as assigned.
What's in it for YouOpportunity and Growth
While we are enjoying strong growth, we are still young and evolving, so a creative and motivated leader can make an impact and implement changes that will drive and influence quality over the long term. Spotlight your skill and talent, and after you've enjoyed success in this role, additional opportunities could become available. We're looking for compassionate impact players who want to make a difference.
In addition to working directly with your team and cross-functionally across the company, your efforts will be visible to our senior leaders. Your success in moving the needle will be noticed.
Help Create and Deliver Optimal Care
If you're coming from a productivity-based care model, you will find ConcertoHealth's model to be a breath of fresh air. Our providers are enthusiastic about the degree to which they can help shape care plans for individual patients and their unique circumstances. The model is represented in the graphic, right.
Full Spectrum of Care
Our model creates a team of care professionals with a diverse array of skills, allowing you to exchange ideas and insights with talented professionals. Team members bring different specializations, but they all share a commitment to patient-centered care. This model makes Concerto the perfect name. It reflects our unique approach to healthcare. It’s about how we work in concert with patients, providers, and health plans. Our approach focuses on bringing harmony across the spectrum of a patient’s care, health, and dignity.
Rethinking Relations with Patients
ConcertoHealth reinvigorates the patient to primary care doctor relationship, whether based in the community or system-employed, or at a ConcertoHealth Care Center, and reinforces the doctor's ability to serve as the medical home through population health tools. Along with patient supports including care management and social services, ConcertoHealth equips the provider to understand and manage the patient's comprehensive health care experience, from home to hospital to nursing facility.
In addition to a competitive salary and bonus incentive plan, we offer a full benefits package, including medical and dental insurances, paid-time-off, a 401(k) with company match, license renewal reimbursement and more.
Keys to SuccessSuccess in this role will require a strong leader with outstanding communication skills and the ability to influence and gain buy-in from direct reports as well as other stakeholders. You should be able to successfully navigate an environment ripe with the elements of change -- ambiguity, diverse ideas, evolving policies, for example -- and apply a can-do attitude and positive approach to drive clinical and operational improvements. You should be a person who will make the position your own, bring vision, creativity and at times a thick skin, always working toward an engaged and skilled team and optimal outcomes for patients.
Additionally, to be an outstanding Manager of Care Management, you will be:
- A skilled team builder and trainer
- Flexible and open to fresh ideas
- Dedicated to making a difference daily
- Upbeat / positive