This site uses cookies. To find out more, see our Cookies Policy

Managing Director, Care Management in Southfield, MI at AF Group

Date Posted: 10/5/2018

Job Snapshot

Job Description

The Managing Director, Care Management is responsible for assisting with the development and implementation of a wide range of evidence based clinical programs for all care settings to ensure the following: The quality and continuity of care; effective operational implementation; and measurable clinical outcomes. This role is responsible for maintaining a quality Care Management program that improves benefit cost management, member experience and outcomes, while managing the gap between actual and assigned risk scores while improving Stars scores. This role drives the integration that aligns and grows the capabilities of Member Directed Care Management.



RESPONSIBILITIES/TASKS:

  • Define and deliver complex chronic disease management programs and home-based care innovations directed at the senior market.
  • Combine strategic, analytical and creative thinking to ensure clinical programs meets their Key Performance Indicator (KPIs) and other goals as defined by the executive management team; drive operational programs diligently and continually to achieve results.
  • Monitor systems and performance measures related to clinical quality, stars and productivity.
  • Work with analytics team to create a solid forecasting model, and then make sure we have the people and processes in place to measure and ensure we have program and project capacity to meet our member, patient and provider demand.
  • Responsible to drive activities related to National Committee for Quality Assurance (NCQA) Accreditation and/or Healthcare Effectiveness Data and Information Set (HEDIS) performance ensuring highest level of accreditation.
  • Manage all aspects of HEDIS improvement activities, including outreach, incentives, data integrity and performance. Review and implement new technological tools and processes and foster team concept with internal and external constituencies.
  • Responsible for developing and directing the execution and delivery of specific health care management / clinical performance and Star programs.
  • Review and analyze cost benefit and return on investment analyses for organizational resource allocation and recommend action plans.
  • Drive programs and initiatives to assure member access to care and gaps in care closure. Partner with Quality, Medical Leadership, and Cross functional leadership to ensure established quality goals are met.

DIRECTION EXERCISED:

Directly manages exempt staff. Carries out responsibilities in accordance with company policies and applicable laws. Responsibilities include interviewing, selecting and training employees; planning, assigning and directing work; appraising performance; rewarding and disciplining employees; addressing complaints; and resolving problems. Performs other related duties which may not be specifically listed in the position description, but which are within the general occupational series and responsibility level typically associated with the employee's class of work.

This position description identifies the responsibilities and tasks typically associated with the performance of the position. Other relevant essential functions may be required