Director of Care Management (Partnership In Care)

MetroPlusHealth • New York, NY • 7h ago

Position Overview: Under the direction of the Medical Director for Partnership in Care (PIC), the Director of Care Management (PIC) provides clinical and administrative direction to Partnership in Care management staff who are focused on providing high quality clinical support and health education to members with HIV and those at risk of HIV infection to ensure these members receive the best possible care and achieve optimal health and wellness. The Director of Care Management (PIC) coordinates program functions across MetroPlusHealth Medical Management, Operations, Finance, and Call Center Departments. Scope of Role & Responsibilities: Supervise and provide clinical and administrative oversight to Partnership in Care staff involved in care management activities. Promote and facilitate a multidisciplinary, data-driven approach to coordination of care and plan operations among disciplines. Ensure that standards of HIV care and chronic care delivery models and standards for Plan operations are consistent with the organization’s model of care, current professional standards, prevailing evidence-based practices, compliant with Federal, State and City regulations, and consistent with the mission, vision and values of the organization. Lead interdisciplinary care rounds and conduct regular case reviews with care management staff of complex and/or high acuity cases. Lead engagement with clinical facilities and providers to optimize the management of members with complex care needs. In collaboration with the Director of Community Outreach, Quality and Compliance, provide oversight and supervision of Partnership in Care program staff in the planning, development, implementation, and evaluation of quality improvement initiatives within the Partnership in Care program and within the Division of Medical Management. Ensure staff are fully trained and adherent to established documentation standards. In collaboration with the Director of Community Outreach, Quality and Compliance contributed to the development and maintenance of an effective evaluation and monitoring system and utilized a variety of reports for staff coaching and program improvement. Collaborate with other organizational departments responsible for functional aspects of the HIV Special Needs Plan, including, but not limited to, Integrated Care Management, Behavioral Health, Managed Long-Term Care, Utilization Management, Quality Management, Credentialing, Regulatory Affairs, Compliance, Corporate Affairs, Provider Network Operations, Medicare Services, Information Systems, Finance, Claims, and Member Services and Eligibility. Participate in committees, as assigned. Required Education, Training & Professional Experience: Bachelor's Degree from an accredited college or university is required. Master's Degree from an accredited college or university in Nursing, Social Work, or other healthcare-related discipline is preferred. A minimum of five years of progressive, professional experience in Nursing, Social Work, Health Care Administration, or other healthcare-related experience. A minimum of five years of administrative experience including supervision of staff from diverse professional backgrounds. Experience and knowledge of Managed Care, Case Management, and HIV care are strongly preferred. Experience with developing and delivering staff training and in-services preferred. Bilingual (English/Spanish) preferred. Licensure and/or Certification Required: Valid New York State license and current registration to practice as a Registered Professional Nurse (RN) Nurse Practitioner (NP), Physician Assistant (PA), Licensed Mental Health Counselor (LMHC), Licensed Master Social Worker (LMSW), or Licensed Clinical Social Worker (LCSW) issued by the New York State Education Department (NYSED).5c143e31-5e48-4549-b638-05792d185386

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