Director of Health Care Management

Company: Care Design New York
Location: Albany
Posted on: November 26, 2022

Job Description:

Overview:The Director of Health Care Management role provides oversight and coordination of health care services for the Care Design NY (CDNY) Care Coordination Organization/Health Home (CCO/HH) members and Partners Health Plan (PHP) Managed Care Organization (MCO) members.The Director is responsible for guiding and supporting the day-to-day implementation, evaluation, and continuous improvement of the Health Care Management Plans for CDNY and PHP members. This position is responsible for directly supervising the Health Care Team Regional Registered Nurses, each of whom has critical roles in supporting the members and families we support with access to, and ongoing supports related to all health care supports and services. The Director is a source of expertise and leadership related to all health care supports and services and works collaboratively with all team members to ensure a holistic approach to care.Including CMS Medicare-Medicaid Plan, CMS/NYS FIDA-IDD, NYSDOH CCO, OPWDD Reporting Requirements, and other measures to assess CDNY and PHP performance and to improve the quality outcomes for the people supported by CDNY and PHP. This position works closely with the Chief of Quality Initiatives, Assistant Vice President of Health Care Management, Care Management Department, Chief Medical Officer, Quality and Analytics, Provider Relations, Business Solutions, IT, and any other CDNY and PHP staff members regarding all such matters.At Partnership Solutions, our work is performed in support of, and on behalf of, Care Design NY and Partners Health Plan. As their administrative arm, we share in a unified organizational culture and the work we do is in furtherance of our collective ability to achieve our shared organizational mission, vision, and values as stated below:Purpose - Connecting people to their chosen supports to live a healthy and meaningful life.Vision - We see a world that is accepting, inclusive, and promotes positive health for all individuals with intellectual and /or developmental Disabilities (I/DD).Mission - Our mission is twofold: to provide compassionate, skilled person-centered care planning that includes a holistic approach to health and wellness, and to advocate for a disability inclusive world.Values -Committed - We are committed to developing successful employees across the organization so members and families can receive high-quality supports.Compassionate - We are compassionate about creating open, honest relationships through collaboration, active listening, and showing empathy for others.Connected - We are connected to each other through a sense of belonging that enriches the work environment and shapes a positive experience for members and families. All full-time positions come with generous benefits including $3000 tuition reimbursement per calendar year, and up to $250 of professional development courses! Click here to view the current benefits summary.Responsibilities:Develop and implement policies and standards which detail the requirements for care managers to advocate for, coordinate, integrate, and monitor behavioral health care services for the members who receive services from CDNY and PHP.Educate all employees on the requirements of the relevant health care standards.Serve as the primary liaison to DOH and OPWDD on health care issues.Develop relationships with local hospitals, clinics, developmental disability, and behavioral health care providers to facilitate effective, and high-quality services.Function as a resource to care managers who need assistance with complex or problematic health care issues with members.Participate in teams such as the complex care case reviews, Clinical Rounds, and other teams as needed to problem solve and assist those members most in need of a comprehensive and creative approach.Educate employees on regulations, policies, procedures, resources, and workflows appropriate for their position.Train staff on health care issues, medications, and medication management and proactive practices.Support medication management as prescriber by medical providers.Provide training to care managers focusing on treatment adherence monitoring and effectiveness of treatment.Provide training and support to care managers on chronic conditions management and requirements to support best health and wellness.Work with the executive team to ensure that policies and procedures are effective, integrated, and monitored.Work with Network Development/Provider Relations department to ensure that the availability of disability-educated and competent health care service providers is available to members in all regions.Intervene and advocate when inadequate health care is provided to the member to come to a better level of care is provided.Directly supervises the Health Care team by clearly and appropriately delegating projects, tasks, priorities, team member.Ensure adherence to regulatory requirements such as CMS, NYS DOH Health Home, NYS OPWDD and FIDA IDD Health Plan requirements.Position the organization for future development (e.g., managed care and alternative payment models) by working collaboratively with all internal and external parties as required.Establish continual monitoring processes demonstrating the outcomes of members served by CDNY and PHP and critical performance indicators relevant to Health Care services.Develop and update reports and recommendations as prescribed by business needs or upon request.Evaluate healthcare utilization data and develop educational resources for employees, members, and caregivers.Qualifications:A Registered Nurse licensed to practice in New York state requiredA Master's Degree in Nursing, Public Health, or other health related field preferred5+ years of experience supervising health services2+ years of experience collaborating with people with IDD preferred3+ years of work experience in a managed care plan is preferredExcellent organizational, interpersonal, and verbal and written communication skills required; ability to attend to detail, organize tasks/priorities and complete with accuracyExemplary written and oral communication skills2+ years of experience in successful oversight and leadership of staff responsible for Health Care supports and servicesDemonstrated success in effectively leading diverse teamsDemonstrated leadership skills to supervise and train multiple staff on various projects with competing timelines.Proficiency in navigating through electronic record software programsCare Design NY and Partnership Solutions provide equal employment opportunities to all. We celebrate the qualities that make each of us unique and greatly value how they enrich the work we do. As such, we welcome candidates of color, candidates who identify as gender diverse, neurodiverse candidates, and candidates of all ages with diverse lived experiences and perspectives to apply.Salary starting at: $85,000 / year Salary up to: $135,000 / year

Keywords: Care Design New York, Albany , Director of Health Care Management, Executive , Albany, New York