Summary:

Leads and provides strategic direction for care coordination, case management, and care transitions for members within the Care Coordination Center. The Senior Director oversees and integrates overall operations for all programs, ensuring the efficient utilization of resources and the delivery of quality, cost effective, and efficient healthcare to meet established goals, objectives, policies, and regulatory requirements. Additionally, the Senior Director is responsible for monitoring and assessing trends, developing strategies, and collaborating with internal and external stakeholders to ensure the effectiveness and efficiency of programs.

Essential Functions:

Leads and provides strategic direction for care coordination, case management, care transitions, and related services for members within the Care Coordination Center, ensuring the achievement of the organization's goals and objectives.

Oversees and integrates overall operations (fiscal, human resources, and competency) for all applicable programs, ensuring efficient utilization of resources and delivery of quality, cost-effective, and efficient health care to meet established goals, objectives, policies, and regulatory requirements.

Monitors and assesses trends and best practices in care coordination, case management, care transitions, and makes recommendations to develop/adjust strategies, programs, and service delivery to meet changing business and market conditions, and partners with other Continuum leaders to ensure seamless transition of members.

Leads enterprise initiatives and collaborates with other leaders to drive growth and innovation.

Designs, plans, and implements an effective, efficient, and quality model of care to provide for the needs of members, physicians, and personnel, continually evaluating and improving the quality of care and services provided.

Establishes appropriate program goals, objectives, and related metrics to measure the effectiveness of the program, and develops, monitors, and controls payroll, non-payroll, and capital budgets and expenditures for all programs.

Monitors operational and financial reports and implements improvement plans as required, while ensuring the development and implementation of care coordination, case management, and care transition policies and procedures.

Ensures ongoing education and competence measurement of care coordination, case management, and care transition personnel and collaborates effectively with internal and external stakeholders to ensure the effectiveness and efficiency of programs.

Ensures that care coordination, case management, and care transition services comply with all regulatory,

accreditation, and contractual obligations. Partners with compliance staff to implement mechanisms to monitor compliance with said obligations.

Performs other duties as assigned by executive management.

Qualifications:

Master's degree in business administration, health care administration, operations research, public health

administration, nursing or six (6) years of experience in a directly related field.

High School Diploma or General Education Development (GED) required.

Minimum ten (10) years of experience in health care is required.

Minimum six (6) years of progressive experience in management with understanding of health care reporting and health care analysis.

Strong personnel management capabilities and leadership skills.

Proven ability to determine key business issues and develop effective action plans from multi-disciplinary perspectives.

Demonstrated ability to conduct and interpret quantitative and qualitative analysis.

Ability to use computer systems to educate others and the ability to teach these systems to others.

Computer skills, including proficiency with Microsoft Office Suite programs, with an emphasis on Word and Excel; ability to learn new systems; experience entering and working with data; and comfort and experience using mobile technologies.

Strong communication and follow through skills with a focus on collaboration and customer service.

Demonstrated understanding of and competence in serving culturally diverse populations preferred.

Demonstrated understanding of utilization management, case management, and care transitions concepts, practices, and criteria preferred.