Title: ____Director of Managed Care________
Reports to: ____Assistant Chief Medical Officer
FLSA Status: ____Exempt_________________ Personnel Supervised: ___Case Management Team Members______
POSITION SUMMARY:
The Director of Managed Care will work in coordination and cohesively with the Managed Care team to ensure the successful implementation of Managed Care goals. The main focus of this position will be to improve the health of CFHC patients through outreach and engagement in preventive care and management of chronic health conditions, as well as ensuring the effective utilization of health care resources by managed care patients. The Director of Managed Care will provide supervision to the members of the Managed Care Team in their endeavors to improve overall patient outcomes with their quality of health. Additionally, the Director of Managed Care will
oversee the strategy of successful managed care contract performance.
The Director of Managed Care is responsible, and accountable for establishing, assuring, and assessing quality improvement controls which reflect the most appropriate and effective use of resources in the delivery of primary care within CFHC’s service areas.
The duties outlined which include, but are not limited to, shall be performed in accordance with the defined business process using the corporation’s policies, procedures, Mission and Vision Statements, CFHC’s Performance Expectations, CFHC’s Quality Improvement Plan (QIP), Health Resources Services Administration (HRSA) Compliance, Joint Commission’s Standards and all other Federal and State Guidelines.
MINIMAL QUALIFICATIONS:
• Bachelor's degree in healthcare administration, business, or related field; Master’s degree preferred.
• Valid Driver’s License
• Ability to work effectively with a diverse multidisciplinary team of health care professionals and staff.
• Ability to manage multiple responsibilities and to prioritize scheduling of work.
• Excellent internal and external customer relationship skills.
• Excellent analytical and problem-solving skills.
EXPERIENCE:
• Minimum of 3 years of experience in managed care.
• Experience with electronic medical records.
• Preferred prior experience with Population Health Tools.
• Experience in evaluating and measuring quality measures.
• Experience with Utilization Review
• Experience analyzing Managed Care contracts.
KNOWLEDGE AND SKILLS:
1. Knowledge of patient teaching and education (example: self-blood pressure monitoring, nutrition instruction, diabetes self-care instructions).
2. Knowledge of common medical supplies and equipment.
3. Excellent interpersonal, communication and leadership skills.
4. Ability to demonstrate priority-setting and ability to work in a complex environment.
5. Ability to function with a high degree of independence and collaboration with other health care providers.
6. Commitment to service, quality, and departmental core values.
7. Proficient in data collection and analysis.
8. Proficient in Microsoft Office suite.
9. Intermediate typing skills.
10. Knowledge of medical terminology.
11. Ability to work under tight deadlines and remain flexible.
12. Exceptional team, communication, and written/oral skills.
RESPONSIBILTIES AND PERFORMANCE EXPECTATIONS include, but are not limited to, the following:
1. Use Data and insights to drive improvements in health outcomes utilization.
2. Obtain/maintain proficient knowledge of CFHC’s mission, vision, overarching goal, and performance expectations.
3. Be well versed in the company’s policies and procedures as well as state/federal guidelines and standards of other regulatory agencies.
4. Maintain seamless communication with Assistant Chief Medical Officer for program guidance, goals for outcomes, and reporting of Managed Care outcomes.
5. Provide excellent leadership and work cohesively with the Managed Care Team to identify efficient processes for improved patient health care outcomes as well as training tools to educate all pertinent staff.
6. Manage case assignments, develop plans for improvement, track progress and oversee outcomes for the Managed Care program.
7. Collaborate with Chief Informatics Officer and/or Data Analyst to obtain accurate reports for quality measure outcome information.
8. Coordinate and facilitate patient care through assessment, evaluation, planning, and implementation.
9. Collect, analyze, and report data on established performance measures related to quality outcomes.
10. Oversee the patient engagement strategy for assigned panels and optimizing scheduling based on the patient’s need for preventative care or chronic disease management.
11. Oversee patient panel hospital utilization.
12. Integrate evidence from multiple sources to determine how best to coordinate patient care.
13. Maintain communication with managed care insurance companies as it relates to patient panels, and contract performance.
14. Identify patients who are due or overdue for preventive care as well as ongoing monitoring for chronic conditions.
15. Attend meetings in coordination with the appropriate staff, as requested.
16. Coordinate, as necessary, with other staff members, Department Heads, supervisors, and all other appropriate agencies.
17. Prior to leave (annual and other) provide the Supervisor with a highlighted picture of major or other significant projects underway.
18. Able to work independently as this position may not be in the same physical office space as the other Managed Care Team members for daily routine responsibilities. In addition, this position may require travel to all centers to coordinate patient care.
19. Perform other duties as assigned or necessary.
PHYSICAL REQUIREMENTS:
1. Able to work flexible hours (normal hours will be 8:00am – 5:00pm)
2. Standing/walking/sitting for long periods
3. Independently mobile
4. Ability to lift equivalents to what would be required when (and if) asked to assist and position patients, reposition equipment and lift supplies.
5. Ability to adapt and function in varying environments of workload, patient acuity, worksites, and work shifts.