Company BackgroundHealthmap Solutions is the future of specialty health management that focuses on progressive diseases, with a particular expertise in kidney health populations. Healthmap Solutions uses clinical big data resources and high-powered analytics to power complex specialty health management programs. Healthmap Solutions is a diverse, growing company committed to our clients and our employees. We are champions for better health, for those who need us most.Position Summary:The Program Director of Case Management and Member Engagement (Care Navigation Operations & Engagement) collaborates with care services, clinical, and cross-functional leadership to develop, define, and execute strategies for Healthmap Care Management Programs. This ensures the programs engage members, follow clinical best practices, and achieve performance targets.Responsibilities:Responsible for designing care management service delivery that is aligned with organizational goals for clinical, financial and experience outcomes across all Regional PodsLeverage payer content knowledge to ensure care teams execute against established goals across multiple payersDrive clinical outcomes through workflow design and content to proactively address opportunities for improvement by working with CS Ops ManagementCollaborate with the population health operations and analytics teams to execute organizational strategy and execute quality metric outcomes around the CN program objectivesArticulate barriers and challenges across the management structure to identify solutions that contribute to the development of a sustainable platform for care management programmingWork with CN Ops Leadership on strategic planning, program development and operations management across the regions to ensure CN model is achieving targetsLead the development of well-planned, well-integrated, cost-effective approaches to the case management of members. Ensure proactive intervention and targeted use of case management resources. Coordinate care effectively among all providers to ensure a seamless delivery systemIncorporate evidence based best practice standards into program development. Research, analyze and define programs; develop the structure and key elements of the program; manage the development of new programs from concept to implementation; provide post-implementation monitoring and oversight by working with CS Ops, and cross functional departments for end-to-end alignment on program componentsGather and document clinical and operational business requirements facilitating accurate and efficient translation to IT to establish efficient technology design and deliveryLead end to end Super User Acceptance TestingCollaborate with Reporting and Analytics team to ensure accurate capture of Client SLA documentation to achieve targetsCollaborate with Quality and Clinical Leadership to ensure NCQA accreditation guidelines are following best in class in case management practicesServe as clinical case management subject matter expert for clinical program development and alignment with Member EngagementCollaborate with AI/ML to support Healthmap initiativesMonitor key performance indicators (KPIs) to assist operational performance, identify and address barriers and/or areas for improvementStay updated on industry trends and best practices in healthcare operations and provide suggestions for process improvementAvailable to work outside normal business hours based on business needPerform other operational functions necessary for efficient and successful growth in the marketRequirements:Bachelor’s degree required. Bachelor’s in Nursing or Masters preferred10- 15 years’ experience strategizing and implementing the design of clinical and quality activities, prior experience in healthcare required10 years of progressive leadership management operations experience, preferably in a healthcare settingProven history of generating superior resultsTravel to corporate headquarters as neededSkills:Excellent communication skills, both written and verbal, to effectively convey information to stakeholdersMust be able to work collaboratively in a highly matrixed environmentStrong organizational and multitasking abilities to manage competing prioritiesProficiency in Microsoft Office Suite, including Word, Excel, PowerPoint, and OutlookStrong critical thinking skills to identify and resolve operational challengesAbility to collaborate with team members and stakeholdersTravel:Limited Travel, scheduled per needs of the businessWorking Conditions:All roles require:Sitting - Ability to sit for extended periods stationary or while drivingDexterity/Effort- Repetitive motion for typing and/or texting - Good manual dexterity for handling packages, paperwork, operation of motor vehicles and/or electronic devicesSense Acuity - Ability to see/read computer monitors or other electronic devicesAdditionally, on-site or at location positions (ex. Mailroom, IT or Admin) may require:Lift/Carry/Push/Pull- Occasional movement of equipment, or materials up to 50/75 PoundsBend/Twist- Occasional bending, twisting, and stooping - Occasional need to kneel or crouchAdditionally Traveling positions (ex. Field Care Navigators or Quality Practice Advisors) may require:Sense Acuity - Ability to see/read road signs, maps, and electronic devices- Good visual acuity for driving, including peripheral vision and depth perceptionEnvironmental - Possible exposure to travel, traffic and/or other outdoor hazards- Possible exposure to various weather conditions, including extreme heat, cold, rain, and snow
22 days ago