Director - Care Management Market Liaison

2 days ago

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Medicaid • MyCare Ohio • Health Insurance Marketplace • Medicare Advantage • Health Insurance

1001 - 5000

Description

• The Regional Director, Care Management Market Liaison works directly with leadership in assigned markets in the execution, standardization and support of the Care Management approach in collaboration with care management leadership. • Supports new business readiness and implementation activities, including development of Model of Care documents for Medicare lines of business. • Actively work with Care Management leadership in assigned markets in the ongoing oversight of operational policies, procedures and clinical content. • Develop the portfolio strategy to facilitate alignment across programs, coordination or deliverables and optimization of resources for new and existing markets. • Ensure that strategies are in place for ongoing risk identification, mitigation and contingency planning. • Lead in the development of processes to achieve operational excellence in all areas within the care model for care management in all supported markets. • In collaboration with care management leadership, provide strategic oversight of development and maintenance of documentation related to workflows and processes. • Oversee and control process changes that result from market level regulatory/compliance requirements. • Assist in determination of benchmarks, goals and outcomes for Care Management programs. • Oversee and manage care management policy process (end to end).

Requirements

• Bachelor’s Degree in Finance, Business, or Health Care field or equivalent years of relevant compliance, strategy or clinical implementation work experience is required • Minimum of five (5) years of experience in health care is required in care management • Minimum of five (5) years of clinical improvement or process redesign experience is required • Minimum of five (5) years of management experience is required • Current, unrestricted Registered Nurse (RN)/LCSW licensure preferred • Case Management Certification (CCM) preferred