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Position: Director, Care Delivery
Position Summary: Oversees a staff of case managers and social workers responsible for patient care coordination and staff who serve as clinical subject matter experts for clients implementing care management programs. Develops and implements case management programs, including intake or discharge planning, complex case management, and transition of care programs. Evaluates patient care data to ensure that care is provided in accordance with clinical guidelines and organizational standards. Develops partnerships with providers and clients to achieve quality and cost management objectives.
Job Description: Role and Responsibilities: - Responsible for day-to-day operations and supervision of case management departmental activities in accordance with administrative and departmental policies and procedures and applicable federal and state requirements
- Act as a client facing clinical subject matter expert and a clinical point of contact
- Assist in determining client strategy based on client specific information
- Provide clinical expertise to Product Development in the development of applications and tools.
- Act as a clinical subject matter expert and a point of contact on matters of clinical content
- Implement, maintain, and report on a Medicare Quality Improvement Project and Chronic Care Improvement Project
- Ensure regulatory compliance and maintain routine monitoring and oversight of the organizationase management programs
- Manage process improvement initiatives, develop and implement workflows and develop policies and procedures
- Develop, maintain and oversee training materials and programs for case management staff training needs
- Compile and report case management data and other key metrics for internal and client reporting, physician committees, Medical Management Committee, and Quality Committee
- Interact with health plansdical Directors, VP of Health Services and/or physician group partners to discuss clinical questions and concerns regarding specific cases
- Manage and develop direct reports (supervisory, exempt professional personnel and non-exempt personnel) including but not limited to hiring, performance reviews, and terminations
- Perform special projects as needed
Experience, Qualifications and Education:
- Ability to lead/manage others; successful management experience
- Strong problem solving and issue resolution skills
- Excellent interpersonal, verbal, and written communication skills
- Ability to effectively present information and respond to questions from families, members, providers, and clients, as well as the ability to relate effectively to upper management
- Ability to work independently, handle multiple assignments, establish priorities, and demonstrate high level time management skills
- Strong clinical knowledge of broad range of medical practice settings and healthcare delivery systems
- Thorough and solid knowledge of health care and managed care delivery systems. This includes standards of medical practice, insurance benefits structure, and the utilization and case management process
- Knowledge of state and federal laws and resources, especially Medicare
- Knowledge of utilization and case management principles and criteria sets such as InterQual, Medicare guidelines, etc.
- Proficiency in Microsoft Office including Outlook, Word, Excel and PowerPoint; knowledge of or the ability to learn care management software (e.g., CCMS, Jiva) and other software in order to perform job duties
Benefits: In addition to competitive salaries, challenging work assignments, and developmental opportunities, Lumeris offers employees a comprehensive benefits package to include medical, dental, vision, life insurance, short-term and long-term disability, paid time off (PTO), matching 401K, and tuition assistance.
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Lumeris is an EEO/AA employer M/F/V/D.
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Location: Remote - NJ
Time Type: Full time
Status: 1 - FT
