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J215069

Director Care Management

Highmark Wholecare

  • Company April 2022 Ed (1)
  • Home, PA
  • Clinical Services
  • Full time
  • Day (United States of America)

Company :

Highmark Wholecare

Job Description : 

JOB SUMMARY


This job develops and ensures execution of the strategic and operational plans for care management and special needs program development, delivery and evaluation.  The incumbent is accountable for all aspects related to care delivery, member outcomes, and financial performance goals.  Provides leadership to support effective care management processes and programs for members with complex medical, behavioral and psychosocial needs.  Special attention is given to those identified as high profile or sensitive by internal sources, DPW, CMS, or other external entities.  Oversees development, implementation and evaluation of Disease Management and Preventative Health Programs and outreach/interventions with members.  Ensures collaboration with program development, care management and external agencies to identify member need and develop program content related to clinical or psychosocial conditions/risk factors.  Establishes and monitors goals, benchmarks, and work plans for projects to ensure consistency with corporate and departmental objectives and measurable outcomes.  Develops and implements annual department budget and staffing plans.  


ESSENTIAL RESPONSIBILITIES  

  • Perform management responsibilities to include, but are not limited to: involved in hiring and termination decisions, coaching and development, rewards and recognition, performance management and staff productivity.  Plan, organize, staff, direct and control the day-to-day operations of the department; develop and implement policies and programs as necessary; may have budgetary responsibility and authority.
  • Direct all management activities for Care Management Departments.
  • Ensure staff compliance with internal and external regulatory requirements and profession practice standards.  
  • Recruit and approve hiring of staff; performance management; coaching, training and resource planning of staff; ensure departmental staffing supports the corporate standards.
  • Develop, gain approval for and implements strategic plan and annual operating plan.  
  • Monitor all aspects of the care management process, including but not limited to, assessment, care plan development, interventions, and quality management.  
  • Ensure implementation and measurement of care management performance standards.
  • Develop and implement policies, procedures and training to ensure compliance and effective service/program delivery.  
  • Identify, develop and implement process improvements which are focused on quality, utilization, cost containment and outcomes.  
  • Oversee and approve research and development of programs that improve clinical outcomes and member satisfaction.  
  • Ensure appropriate and cost effective utilization of health care resources, including the integration and evaluation of quality of care measures.
  • Accountable for outreach delivery and measurement of impact.
  • Ensure new and existing program review evaluation.  
  • Develop and implement annual department budget and staffing plan.  
  • Other duties as assigned or requested.

EDUCATION

Required

  • Bachelor’s Degree in Business or Health-related Field

Substitutions

  • 10 years care/case management experience

Preferred

  • Master's Degree in Business or Health-related Field

EXPERIENCE

Required

  • 5 years in managed care, specifically in case management, utilization management and/or discharge planning
  • 5 years in a management/supervisory role

Preferred

  • None

LICENSES OR CERTIFICATIONS

Required

  • Registered Nurse (RN) or Licensed Social Worker (LSW)
  • DE license is required in addition to the home state license unless the home state license is part of the compact. The additional DE license must be obtained within the first 6 months of employment

Preferred

  • None

SKILLS

Language (Other than English):

None

Travel Requirement:

0% - 25%

PHYSICAL, MENTAL DEMANDS and WORKING CONDITIONS

Position Type

Office-based

Teaches / trains others regularly

Frequently

Travel regularly from the office to various work sites or from site-to-site

Occasionally

Works primarily out-of-the office selling products/services (sales employees)

Never

Physical work site required

Yes

Lifting: up to 10 pounds

Constantly

Lifting: 10 to 25 pounds

Rarely

Lifting: 25 to 50 pounds

Never

Disclaimer: The job description has been designed to indicate the general nature and essential duties and responsibilities of work performed by employees within this job title. It may not contain a comprehensive inventory of all duties, responsibilities, and qualifications required of employees to do this job.

Compliance Requirement : This job adheres to the ethical and legal standards and behavioral expectations as set forth in the code of business conduct and company policies.


As a component of job responsibilities, employees may have access to covered information, cardholder data, or other confidential customer information that must be protected at all times.  In connection with this, all employees must comply with both the Health Insurance Portability Accountability Act of 1996 (HIPAA) as described in the Notice of Privacy Practices and Privacy Policies and Procedures as well as all data security guidelines established within the Company’s Handbook of Privacy Policies and Practices and Information Security Policy. 

Furthermore, it is every employee’s responsibility to comply with the company’s Code of Business Conduct. This includes but is not limited to adherence to applicable federal and state laws, rules, and regulations as well as company policies and training requirements.

Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities, and prohibit discrimination against all individuals based on their race, color, age, religion, sex, national origin, sexual orientation/gender identity or any other category protected by applicable federal, state or local law. Highmark Health and its affiliates take affirmative action to employ and advance in employment individuals without regard to race, color, age, religion, sex, national origin, sexual orientation/gender identity, protected veteran status or disability. 

EEO is The Law

Equal Opportunity Employer Minorities/Women/Protected Veterans/Disabled/Sexual Orientation/Gender Identity ( https://www.eeoc.gov/sites/default/files/migrated_files/employers/poster_screen_reader_optimized.pdf )

We endeavor to make this site accessible to any and all users. If you would like to contact us regarding the accessibility of our website or need assistance completing the application process, please contact number below.

For accommodation requests, please contact HR Services Online at HRServices@highmarkhealth.org

California Consumer Privacy Act Employees, Contractors, and Applicants Notice


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