DIRECTOR OF CARE COORDINATION AND COMPLEX CARE MANAGEMENT

Cook County•Chicago, IL

About The Position

The Director of Care Coordination and Complex Care Management is responsible for the planning, organization, staffing and implementation of Care Coordination and Complex Care Management Services for Health Plan enrolled populations. Leads and inspires a team of clinical and non-clinical staff to support health plan members of all risk levels and needs. This position will be responsible for supporting the achievement of service and quality goals required by regulatory and accreditation organizations. Oversees the day-to-day care coordination activities to ensure contractual requirements are met, compliant, and of high quality. Assures the appropriateness and effectiveness of care coordination

Requirements

Licensed as a Registered Professional Nurse, Licensed Clinical Social Worker, Licensed Social Worker, Licensed Clinical Professional Counselor or Licensed Professional Counselor, is required (Must provide proof at the time of interview)
Master's degree in Nursing, Public Health, Business Administration, or Health Care focus from an accredited college or university, is required (Must provide official transcripts at time of interview)
Five (5) years of management work experience, is required
Two (2) years of care coordination experience in a managed care plan or for a managed care population, is required
Position may require moderate travel for which the employee must have a valid driver’s license/insured vehicle or other equivalent means of transportation for work, is required
In-depth knowledge of publicly funded programs such as Medicaid, Medicare and accreditation standards.
Knowledge of SharePoint software.
Knowledge of Microsoft Office.
Excellent verbal and written communication skills necessary to communicate with all levels of staff and a patient population composed of diverse cultures and age groups.
Ability to successfully manage a budget, achieve goals and present data to support effective operations.
Ability to assist teams to respond positively to change.

Responsibilities

Determines approaches to excel in performance, set goals, create and implement action plans and evaluate outcomes.
Provides oversight for the care coordination program development and design; measures outcomes to ensure they meet all contractual requirements and accreditation standards that are consistent with care coordination best practices and reflects the needs of the Enrollee population.
Manages the program to achieve outcomes within budgetary parameters and available resources.
Participation in audit processes ranging from lead to participant. Supports and monitors the Manager of Complex Care Coordination to administer care coordination in an appropriate and effective manner.
Monitors compliance with regulations including State and Federal guidelines ensuring implementation of regulatory changes.
Supports the achievement of milestones and targets for care coordination that are outlined in the organization’s strategic plan as described in quality and clinical initiatives.
Ensures meaningful use oof data sources to support decision making, program planning and care coordination evaluation.
Identifies and implements best practices through expert panels and literature, industry standards, external audit findings and reviews to support efficient resource utilization and community resources.
Works to achieve and/or maintain National Committee for Quality Assurance (NCQA) accreditation for Cook County Health (CCH) care coordination activities.
Prepares annual summary of program achievements and plans for upcoming year.
Develops policies and workflows to adhere with all relevant regulatory and program requirements and ensure health, safety and welfare
Develops onboarding and ongoing training strategies and methods to develop staff skills, ensure mandated training requirements, and achieve program goals.
Oversees an effective and culturally competent field-based model of care coordination that meets or exceeds all relevant standards of care
Supports effective problem solving and dispute resolution.
Designs, analyzes, and presents reports and findings to facilitate effective operations and represent the health plan in internal and external forums.
Supports managed care organization (MCO) contractual requirements such as care gap closures, transitions of care for active care coordination cases, and specialized population health programs. as appropriate.
Serves as a representative of the Health Plan and CCH representative to work with external entities such as community groups, other payers and stakeholders.
Collaborates with CCH leadership and provider groups staff to ensure integration and coordination of care as well as departmental/organizational goals.
Performs other duties as assigned