Details
Posted: 16-Jun-22
Location: Poughkeepsie, Town of, New York
Type: Full Time
Salary: Open
Categories:
General Nursing
Internal Number: DIREC005377
This role is responsible forLeading clinical and administrative operations for Optum care of New York (OCNY) Population Health and Medical Management Department. Function is responsible for directing clinical operations and medical management activities across the continuum of care (assessing, planning, implementing, coordinating, monitoring, and evaluating). This includes case management, coordination of care, and medical management consulting, health education, coaching and treatment decision support. Establishes effective partnerships with hospitals, skilled nursing facilities, home care agencies and other community-based organizations to develop a network for provision of high quality of care. Provides leadership to and is accountable for the performance and direction through multiple layers of management and senior level professional staff. Work most often impacts a large business unit, or multiple markets/sites.
ESSENTIAL FUNCTIONS AND RESPONSIBILITIES
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. Reasonable accommodations may be made to enable qualified individuals with disabilities to perform the essential functions
* Direct the clinical and administrative operations and promote growth and development of staff
* In coordination with VP of Medical Management responsible for growth and development of the population health management and medical management programs.
* Work closely with VP of Medical Management and Medical Director to execute on all initiatives, new programs and goals
* Understand client goals, expectations, and objectives that drive a positive member and client experience as well as obtain compliant outcomes and maintain fiscal responsibility
* Understand service and provider platforms and act as a subject matter expert (SME) to support projects, regulatory issues, and initiatives
* Drive utilization and affordability initiatives through strategic action planning and execution within the region
* Ensure market compliance with all federal and state regulations, accreditation organizations, and client requests
* Provide oversight of clinical team activities, staff development, budget management, regulatory compliance, and audit readiness
* Conduct employee performance reviews
* Remain accountable for all operational plans, produce and report key metrics, and conduct regular clinical operational meetings
* Cultivate a strong internal culture designed around collaboration, feedback, motivation, and accountability
* Collaborate with internal and external business partners to maintain all contractual performance guarantees
* Drive programs/project implementation on time and within budget while securing necessary resources.
* Delegate escalated clinical decisions and patient facing recommendations to Clinical Managers
* Manage clinical utilization and outcomes activities within the assigned market
* Collaborate with peers and staff to ensure the understanding and execution of operational and business requirements
* Manage and innovate with peers in areas such as quality, product, training, health services, compliance, network, and all others across the organization
* Set the example of team collaboration as well as clinical collaboration throughout other regions
* Perform other duties and responsibilities as required, assigned, or requested
Required Qualifications:
To perform this job successfully, an individual must have the following education and/or experience.
* Current, unrestricted RN license required, specific to the state of employment
* Bachelor of Science in Nursing, Healthcare Administration, or a related field
* 10+ years of diverse clinical experience; preferred in managed care (delegated medical management), Complex Case Management, Disease Management and Transitional Case Management
* 5+ years of recent leadership experience with ability to partner with staff to build high-performing teams.
* Expert knowledge of case management principles, as evidenced by certification in Case Management (CCM) or willing to obtain within 6 months of employment.
* Knowledge of relevant state and federal guidelines (e.g., Medicare, Medicaid, SNP, Commercial) and regulatory bodies (e.g., CMS, NCQA, URAC, InterQual)
* Solid leadership skills, demonstrated by the ability in leading large teams of individuals to successful outcomes
* Experience managing direct reports to performance metrics
* Proficient with Microsoft Office applications including Word, Excel, and PowerPoint
* Willing to occasionally travel as deemed necessary
Preferred Qualifications:
* Master of Science in Nursing, Healthcare Administration, or a related field
* 15+ years of managed care, Complex Case Management, Disease Management and Transitional Case Management experience
* Knowledge of utilization management, quality improvement, and discharge planning
* Ability to cultivate a strong internal culture designed around collaboration, feedback, motivation, and accountability
* Solid communication and interpersonal skills
* Demonstrated ability to work in a fast pace, multi-tasking team environment while meeting deadlines
* Highly skilled in leading change efforts and in building strong partnerships with business-line executives
* Ability to summarize complex issues and problems into a concise report focused on key findings and outcomes
* Ability to consistently manage up and down
* Ability to complete initiatives with minimal supervision
* Proficiency in developing communication strategies for a wide array of audiences that support strategic objectives
* Demonstrated sophisticated written and verbal presentation abilities; experience with the development of presentation materials (collateral, proposals, presentations, talking points, etc.)
* Proven proficiency in the management of time, flexibility, and influencing colleagues to meet demanding project/requested timelines
Physical & Mental Requirements:
* Ability to lift up to 25 pounds
* Ability to sit for extended periods of time
* Ability to stand for extended periods of time
* Ability to use fine motor skills to operate office equipment and/or machinery
* Ability to receive and comprehend instructions verbally and/or in writing
* Ability to use logical reasoning for simple and complex problem solving
Full COVID-19 vaccination is an essential requirement of this role. CareMount will adhere to all federal, state and local regulations as well as all client requirements and will obtain necessary proof of vaccination prior to employment to ensure compliance.
All qualified applicants will receive consideration for employment without regard to race, ethnicity, color, religion, sex, gender identity, sexual orientation, national origin, disability, or protected veteran status. CareMount is an EO employer - M/F/Veteran/Disability
