Director, Clinical Operations - Care Management(Must Live In Mississippi)

Job Summary:

The Director, Clinical Operations - Care Management directs and oversees the key functions of a team that works with members, providers and multidisciplinary team members to assess, facilitate, plan and coordinate an integrated delivery of care across the continuum, including behavioral health, for members with high need potential, ensuring that patients progress toward desired outcomes with quality care that is medically appropriate and cost-effective based on the severity of illness and the site of service.

Essential Functions:

• Develops, implements and/or monitors standardized protocols for clinical and non-clinical team activities to facilitate integrated proactive care review and management.
• Develops, performs and promotes interdepartmental integration and collaboration to enhance clinical services.
• Facilitate/promote problem identification, analysis and resolution within clinical operations to improve member experience
• Utilize formal and informal meetings to gather information and provide feedback and developmental ideas to all levels of staff within the Care Management structure and dependent teams within clinical operations
• Collaborates with and keeps the VP informed of operational issues, staffing, resources, system and program needs and presents solution action plan for issues.
• Department goal setting to meet regional market-specific objectives
• Monitor all regulatory requirements and oversight of all submissions in existing and future lines of business
• Facilitates and participates in committees, task forces, work groups and multidisciplinary teams as needed to promote standardized enterprise wide approach to Care Management programs.
• Understands the mission and ensure alignment of compliance-based activity in strategic planning / department goal-setting and regional market support
• Oversight and evaluation of clinical processes to ensure continuous review and improvement of business process workflow
• Establish strong operational metrics and auditing to ensure quality
• Analyze data and identify trends monthly to ensure company expectations meet or exceed industry benchmarks, regulatory requirements, and SLAs.
• Responsible for ongoing communication with market leaders to report outcomes, adherence to corrective action plan, and collaborate with regulatory agencies as appropriate.
• Perform any other job duties as requested

Education and Experience:

• Bachelor’s degree or equivalent years of relevant work experience is required; Master’s degree is preferred
• A minimum of five (5) years of managed healthcare experience with line management responsibility including clinical operations is required
• A minimum of two (2) years of experience developing programs/processes to support care management and member wellness is required
• Experience working within applicable state, federal, and third-party regulations is required
• Operational and process improvement experience is preferred

Competencies, Knowledge and Skills:

• Display a customer service, member-focused orientation
• Strong data analysis and trending skills
• Strong project management skills
• Strong team and staff development skills
• Strong collaboration and conflict resolution skill sets
• Proven leadership with the ability to build relationships/collaborate and influence at all levels
• Strong process and analytical skills with the ability to articulate and define outcome measures that capture key performance metrics
• Ability to develop, prioritize and accomplish goals/time management
• Strong decision making and problem-solving skills
• Exceptional communication skills (both written and verbal) with the ability to present information in a variety of different formats to all levels
• Strong ability to teach best practice, engagement strategies for successful member participation (including motivational interviewing, best practice engagement techniques)
• Executive and Strategic management skills
• Ability to work in a fast-past environment
• Ability to work independently and within a team environment
• Advanced knowledge of Microsoft Word, Excel, PowerPoint and Visio

Licensure and Certification:

• Active, unrestricted State Registered Nursing (RN) license, Social Work license, or Counselor license is preferred
• Healthcare or Management certification is preferred
• To help protect our employees, members, and the communities we serve from acquiring communicable diseases, Influenza vaccination is an essential requirement of this position. CareSource requires annual proof of Influenza vaccination for designated positions during Influenza season (October 1 – March 31) as a condition of continued employment. Employees hired during Influenza season will have forty-five (45) days from their hire date to complete the required vaccination. CareSource adheres to all federal, state, and local regulations. CareSource provides reasonable accommodations to qualified individuals with disabilities or medical conditions, sincerely held religious beliefs, or as required by state law to enable the employee to perform the essential functions of the position. Request for accommodations will be reviewed by the CareSource Health & Wellness team.

Working Conditions:

• General office environment; may be required to sit or stand for extended periods of time
• Ability to travel as required by the needs of the business

Compensation Range:

CareSource takes into consideration a combination of a candidate’s education, training, and experience as well as the position’s scope and complexity, the discretion and latitude required for the role, and other external and internal data when establishing a salary level. We are highly invested in every employee’s total well-being and offer a substantial and comprehensive total rewards package.

Compensation Type (hourly/salary):

Organization Level Competencies

• Create an Inclusive Environment

• Cultivate Partnerships

• Develop Self and Others

• Drive Execution

• Influence Others

• Pursue Personal Excellence

• Understand the Business

TrueCare is a Mississippi non-profit, provider-sponsored health plan formed by a coalition of Mississippi hospitals and health systems throughout the state and supported by CareSource’s national leadership in quality and operational excellence. TrueCare offers locally based provider services through provider engagement representatives and customer care. Our sole mission is to improve the health of Mississippians by leveraging local physician experience to inform decision-making, aligning incentives, using data more effectively, and reducing friction between the delivery and financing of health care. By doing so, TrueCare will change the way health care is delivered in Mississippi.

This job description is not all inclusive. CareSource reserves the right to amend this job description at any time. CareSource is an Equal Opportunity Employer. We are dedicated to fostering an inclusive environment that welcomes and supports individuals of all backgrounds.