Director Health Care Management Services Job at Columbia

Job Description

Director Health Care Management Services

Job ID 2013-23151 # Positions 1
Location US-SC-Columbia
Search Category Nursing
Type Regular Full-Time (30+ hours) Posted Date 6/18/2013
Additional Locations ..

More information about this job:
Summary:

Key leadership role responsible for leading the development, implementation and coordination of a comprehensive health care program that will assist Health Care Management Services, Medical Management, and/or Utilization management, resulting in improved health outcomes for members.

Responsibilities:

1. Assists leadership peers in the development and implementation of clinical programs in accordance with the goals of Amerigroup Corporations mission, vision and values, the needs of the health plans, federal and state regulatory requirements and NCQA standards. 2. Serves as a clinical leader to HCMS/Medical Management associates and Managers.

3. Provides departments with updates as needed to ensure continued compliance with specific medical management standards.

4. Assists leadership peers in the development of medical management policy, procedures and guidelines that relate to specific programs.

5. Provide contracting feedback recommendations based on identified network gaps and feedback from CMS associates.

6. Participates in complaint resolution and inquiries pertaining to HCMS programs.

7. Assists in developing clinical management guidelines, policies, and strategies.

8. Acquires data and evaluates necessary medical, mental health and substance abuse services for cost containment.

9. Ensures that delegated medical management activities are contracted, reviewed and reported according to established criteria.

10. Ensures program deliverables by monitoring established goals and implementing improvement strategies accordingly.

11. Supports and participates in quality initiatives and activities including clinical indicators reporting, focus studies and HEDIS reporting.

12. Ensures compliance with state reporting on healthcare management activities for accuracy.

13. Other duties as requested or assigned.

Qualifications:

EDUCATION AND EXPERIENCE:

Education

Required:
- Bachelors Degree in related Health/Nursing field

Preferred:
- Masters Degree in related Health/Nursing field

Years and Type of Experience Required:

Required:
- Minimum of seven years clinical work experience, with at least three years of leadership/management experience.

Certifications or Licensures

Required:
- RN,LCSW, or LPC

Preferred:
- Certified Case Manager

Language Skills

Required:
- English

Functional Competencies
- Proficient in the use of Microsoft Office products, to include Outlook, Word, Excel and PowerPoint.
- Excellent problem solving skills; ability to multi-task and solve complex problems.
- Excellent organizational and analytical skills.

SCOPE INFORMATION

# Direct Reports: 2-10

# Indirect Reports: 2-20

Budgetary $ Responsibility: As assigned

PHYSICAL REQUIREMENTS

The physical requirements described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
- Must be able to operate general office equipment including but not limited to: computer, phones and related media and information devices.
- Ability to communicate both in person and/or by telephone.
- Must be able to travel as needed and adhere to Amerigroup travel policies and procedures.

CB1

ermHO
Healthcare Operations

Job Requirements

 
Country: USA, State: South Carolina, City: Columbia, Company: WellPoint.