Role: Clinical Innovations Director Assignment: Director of Operations, Case Management, Are you a fit? Are you innovative and enjoy defining strategy? Would you enjoy using your business knowledge to lead teams to create and maintain programs that align local strategy with larger business objectives? If this describes you, then read on! Assignment Capsule As a Clinical Innovations Director you will lead and manage strategy and company Capital to develop and implement integrated Clinical programs which are value added.
Develop and manage programs that reach measurable qualitative and financial metrics
Recruit and develop talent, facilitating good team and succession planning
Participate in an integrated fashion with other areas of Clinical activity
Maintain strong, working relationship with internal stakeholders
Design and develop new initiatives within case management program for process improvement and communicating recommendations for change to senior leadership
Interface with acute, chronic, and wellness domain leaders in the evaluation and creation of initiatives to support clinical program improvements
Operationalize new clinical strategies presented by clinical strategy or company and CGO business processes
Direct the case management quality initiatives including business performance indicators and analysis of program results in conjunction with program leadership team. This includes department accreditation or certification for URAC and NCQA case management core standards and utilization process impacted by case management
Assure CM department preparation for ISO registration and ongoing process improvement efforts to align with ISO standards
Direct oversight for departmental communications efforts such as responding to RFPs, providing informational presentations to internal/external customers, working with marketing department to develop communication materials, etc
Conduct monthly, quarterly and annual analysis/ review of case management department metrics and operational reporting package. This includes offering recommendations to impact clinical metrics.
Direct supervision of the Case Management Regional Process Managers who serve as regional/market operational leaders
Representation of case management program in leadership, regional, marketing, customer or professional associating meetings. This will include development of presentation materials
Development and submission of staffing models to assure case management coverage and support staff to assure quality delivery of case management services to commercial members
Builds Human Capital: You deliver current, direct, complete and actionable feedback to associates to support continuous learning and growth; while ensuring that diverse perspectives are widely held, modeled and promoted. By selecting, deploying, developing and rewarding diverse talent, you are able to foster company strategy and meet business requirements.
Acts Strategically: You foster a consistent understanding of strategy, translate it into defined plans, and "stay the course" to implement it, while anticipating and identifying where change is needed.
Communication: You actively listen to others to understand their perspective and ensure continuous understanding regardless of communication channel or audience.
Leadership: You inspire extraordinary results by: engaging associates, valuing diversity and shaping culture to support a high performance environment.
Bachelorís Degree or higher in nursing or business-related field require
Knowledge of Case Management process, including staffing ratios, practice guidelines and staff development
Proficiency in analyzing and interpreting financial trends
Comprehensive knowledge of all Microsoft Office applications, including Word, Excel and Access
Minimum of 5 years experience in leadership role of health services related field, i.e. case management, utilization management, disease management
5-7 years management experience with oversight of clinical professionals (MD, RN, LPN, Social Worker)
Excellent organizational and time management skills required
Previous experience in program/process development preferred
Must possess good analytic and problem solving skills
Ability to work with minimal supervision and self-manage time
Ability to manage budget or large department with staff of 100 or more associates
Masterís Degree in Business Administration or a related field
Knowledge of URAC and NCQA standards related to UM and CM
Reporting Relationships You will have 8- 10 direct reports and you will report to the Director of Clinical Operations.