Allegiance Benefit Plan Mgmt.
  • 10-Jan-2020 (MST)
  • Missoula, MT, USA
  • DOE
  • Salary
  • Full Time

Full Benefit Package


A new position has opened up at Allegiance Director of Care Management! At Allegiance, we pride ourselves on the excellent employees we have, and we are seeking a new Director of Care Management to add to the team! The qualified candidate chosen will oversee overall strategy, operational performance and outcomes of the Care Management department.  They will also collaborate across the enterprise and with clients to ensure that objectives are aligned, business strategies are delivered, and that financial, compliance and quality objectives are met.

REPORTS TO:  Senior Vice President              LOCATION: Missoula                           FSLA STATUS: Exempt           

POSITION RESPONSIBILITIES:

The Director Care Management is responsible for the overall strategy, operational performance and outcomes of the department's care management activities. This position manages the design, development, and refinement of care management and associated functions to create a continuum of integrated care and experience for our members. The director collaborates across the enterprise and with clients to ensure that objectives are aligned, business strategies are delivered and financial and compliance and quality objectives are met. Provides leadership and operational oversight of Care Management programs. Provides leadership and direction to the Care Management management team and is responsible for oversight and maintaining of URAC accreditation.

 

The incumbent is expected to conduct all communication and assignments professionally with peers, supervisors, subordinates, vendors, customers, and the public.

 

ESSENTIAL JOB FUNCTIONS:

Essential job functions include the following. Other functions may be assigned as business conditions change.

 

  • Strategic development and implementation of care management programs
  • Provide strategic direction, leadership, and operations oversight to programs and staff to optimize efficiency and effectiveness of Care Management operations
  • Responsible for maintaining confidentiality standards, as mandated by URAC and HIPAA.
  • Collaborate with strategic partners to innovate, design and deliver market differentiating health management strategies that align to corporate initiatives.
  • Communicates and collaborates with senior medical director and Chief Medical Officer for medical management, clinical programs and clinical issues that arise
  • Direct operational readiness and regulatory/accreditation compliance via formal processes such as policy and procedure, program descriptions, auditing, training, and metric monitoring and management.
  • Lead the evaluation of program performance based on analysis of data and market requirements to identify and act on opportunities to enhance and improve.
  • Oversees the development and coordination of quarterly productivity reports and client reporting.
  • Create and foster an environment where Care Management staff can work effectively and efficiently.
  • Leads and directs a high performing team including interviewing and hiring employees. Conducts performance evaluation and is responsible for managing employees, including skill and career development, policy administration, coaching on performance management and behavior, employee relations and cost control.
  • Oversees the onboarding process of new Care Management staff and training processes to ensure staff are set up for success
  • Develop educational plans and implementation of annual training for skill and career development of staff
  • Works collaboratively with the implementation team and workflow process when adding new clients
  • Facilitate and monitor client reporting
  • Oversee the cost savings analysis for the Case Management and Utilization Management staff for the individual group plans.
  • Oversee URAC compliance and application/certification processes for the Utilization Management Department.
  • Participate in administrative meetings with Care Management customers, Account Representatives or other group contacts upon request as assigned by supervisor.
  • Performs other duties and responsibilities as assigned.

PHYSICAL WORKING CONDITIONS:

Physical requirements are representative of those that must be met to successfully perform the essential functions of this position. Reasonable accommodations may be made to enable individuals with disabilities

to perform the essential functions.

 

Sitting                     80%                                                      Reaching                      Minimal

Standing                 10%                                                      Manual Dexterity           Ability to type/keyboard

Walking                  10%                                                      Telephone                     High Degree

Kneeling                 Minimal                                                Computer Screen          High Degree

Bending                  Minimal                                                Lifting                           20 pounds

 

JOB SPECIFICATIONS:

To perform this position successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions

 

  • Bachelor's degree in health care administration, healthcare management, bachelor of science nursing and 5 years of progressive experience in the health care industry or 10 years of relevant experience in lieu of degree.
  • 3 years of progressive management experience.
  • Current licensed clinician
  • Demonstrated maturity, flexibility and capacity to navigate a complex structure with strong critical thinking, problem solving/conflict resolution skills.
  • Superior facilitation, written and oral communications skills to convey complex ideas simply, through written reports and presentation materials.
  • Strong leadership skills with the ability to generate ideas, support and commitment from constituents.
  • Demonstrated team building, mentoring and coaching skills with experience leading professional staff.
  • Demonstrated knowledge of healthcare payer industry and business processes.
  • Ability to see across the enterprise and identify potential risks and issues that influence other ongoing work efforts.
  • Strong teamwork and interpersonal skills at all levels.
  • Must be able to work effectively with cross functional groups, fostering teamwork with a commitment to quality.
  • Strategic thinking and critical decision making at an enterprise level.

 

PREFERRED REQUIREMENTS:

 

  • Advanced degree

 

The above statements are intended to describe the general nature and level of work being performed. They are not intended to be construed as an exhaustive list of all responsibilities, duties, and skills required of personnel as classified. By signing this statement, the employee understands the scope of their licensure and will practice within the scope of that licensure. If the status of the licensure/certification changes, the employee will notify the department supervisor of the change immediately. The employee understands that failure to maintain current licensure and/or to practice within the scope of that licensure, as well as failure to report any changes in license status, will result in disciplinary action, up to and including termination.

Allegiance Benefit Plan Mgmt.
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