Associate Director, Care Management

viva health•Birmingham, AL

59d

About The Position

The Associate Director, Care Management will be responsible for the oversight of the day-to-day operations of the Care Management department to include applicable contracted programs. This position is responsible for the coordination, development, administration, and implementation of care coordination and utilization management for the Care Management program and other designated populations. Along with other leaders, this position will develop and implement strategies to improve member outcomes, quality of care, increase member satisfaction, and meet productivity standards. This position will travel to locations within the relevant service area through a reliable means of transportation insured in accordance with Company policy.

Requirements

Graduate of a professional program of nursing or a Master's level degree in a health-related field
5 years of management experience in Acute, Post-acute, or managed care setting
Current RN License or LBSW license in good standing in the State of Alabama
Valid driver's license in good standing
May require significant face-to-face member contact with duties regularly performed away from the principal place of business
Willing to submit to vaccine testing and screening
Possess excellent assessment and organizational skills
Exhibit critical thinking and decision-making abilities, as well as conflict resolution skills
Excellent verbal, presentation, and written communication skills
Comfortable speaking to large groups
Ability to travel overnight as needed
Ability to perform tasks with little or no supervision
Basic computer skills including Microsoft Word and Excel

Nice To Haves

BSN or a Master's in Social Work
Experience in population health and/or chronic care disease management
Experience working for a Medicare Advantage Plan or Medicaid Plan
Current LMSW license in good standing in the State of Alabama
Chronic Care Management (CCM)
Knowledge of community resources and Medicaid regulations

Responsibilities

Make all day-to-day program decisions including overseeing all personnel within the department to ensure staff is providing quality customer service and meeting productivity and quality benchmarks.
Ensure department is appropriately staffed with qualified and trained employees. Coach and motivate employees by modeling behavior consistent with VIVA HEALTH'S Core Values. Assess and manage performance of management staff; create a positive environment that encourages productivity, innovation, and compliance.
Work in collaboration with other Health Services leaders and other departments, attaining and improving HEDIS and STARs metrics for VCare and Special Needs Plans (SNP). Meet with external stakeholders as required determining priority areas to be addressed. Implement plans as indicated.
Work in collaboration with other Health Services leaders to evaluate opportunities to impact and improve internal processes and best practice for the team.
Execute strategies, monitor their success on an on-going basis, report on outcomes, and adjust strategies as needed.
Support the design and oversight of initiatives aimed at improving member health outcomes including transitions of care, complex case management, and social determinant of health interventions.
Oversee the review and validation of program reports and data files to ensure accuracy, completeness, and alignment with Centers for Medicare and Medicaid Services (CMS) and internal benchmarks. Collaborate with analytics and quality teams to identify discrepancies and ensure timely resolution.
Review and analyze data reports to identify trends in admissions, readmissions, and utilization patterns. Assess the impact of social determinants of health and other risk factors to develop targeted strategies that close care gaps and reduce avoidable utilization.