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Careers


Director of Care Management

    • Job Tracking ID: 512689-606717
    • Job Location: Milwaukee, WI
    • Job Level: Management
    • Level of Education: Masters Degree
    • Job Type: Full-Time/Regular
    • Date Updated: January 26, 2018
    • Years of Experience: 10 - 15 Years
    • Starting Date: ASAP
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Job Description:

This position manages and directs the Manager of Specialty Services and the Supervisor of the Registered Nurse Case Managers; providers oversight and leadership to the development of the Disease Management RNCMs, and the contribution that nursing brings to care coordinator teams in SSI, SNP and BC+ programs including integration with care coordination health coaches and consultants to ensure the achievement of measured performance outcomes.

Leadership

  1. Demonstrate leadership with nurse leaders and nurse care managers, care coordinators, care teams and manager(s) (if any) of care teams.
  2. Supervise and manage the Manager of Specialty Services and the Supervisor of the Registered Nurse Case Managers (RNCMs).
  3. Work collaboratively with the Managers of Care Coordination and BadgerCare Plus, SSI-Medicaid, SNP and BC+ care coordinators, care managers, health coaches, and consultants, and care teams.
  4. Strengthen the ability of RNCMs to achieve their outcomes, encouraging them to make direct one-to-one use of across department resources to increase "speed to solution," reducing downtime caused by inefficient processes, and providing other efficiency enhancements.
  5. Establish a culture where individual RNCMs participate in the design, development, improvement and implementation of care coordination protocols in collaboration with the Managers of Care Coordination SSI and SNP, BC+ and Specialty Services, and otherwise express their learned judgment in the application of these protocols with individual plan members.
  6. Ensure that there is a common understanding among individual RNCMs regarding Company and Department goals and objectives, outcomes, strategies and procedures.
  7. Ensure that RNCMs understand measured performance delivery protocols, including their necessity, their rationale, their value to members, their importance to the plan’s actuarial integrity, as well as methods for implementation, techniques for effectiveness, variations in application, and the like.
  8. Monitor individual RNCM performance and provide periodic feedback to each RNCM regarding his/her actual performance level(s) compared to planned level(s), including, among others, how each RNCM compares to peers, how each compares to national standards, and the like.
  9. Provide leadership to Grand Rounds, Weekly WICT staffing meetings, Staff Professional Development Committee, the Acuity Assessment Committee, the Member Education Committee, and the Chronic Disease Management Committee.
  10. Provide strong nursing leadership to the following committees: Utilization and Trend Committee (including FCP and BC+ U & T Committees), Solutions Committee, Systems and Quality Committee, Member Satisfaction Committee, Medtronic Meetings, Cost Savings Meetings, ED Reduction Committee, etc.
  11. Manage the RNCM functions and the growth in the role of nursing and its relevance to care management program success along with the FCP Clinical Practice Manager and the Vice President Accountable Care.

Education

  1. Responsible for assisting Vice President of Accountable Care with personnel development including, but not limited to, continuing education, inservices, training sessions, and one-on-one mentoring.
  1. Regularly performs iCare Education needs assessment and develops a wide array of programs to meet identified needs, including an agency education plan.
  2. Oversees continuing education provided internally.
  3. Assists in the creation and distribution of a monthly Education Calendar. Assesses the availability of online education, following a cost/benefit analysis.
  4. Ensures compliance with all state, federal, and human resources regulatory requirements as they pertain to employee education.
  5. Analyzes personnel feedback to evaluate the education provided and to assist in the development of future education programs.

Experience and Skills:

  1. Baccalaureate degree in nursing, therapy, social work or equivalent human service field.
  2. Masters degree in health care field.
  3. 3-5 years work experience as a leader in a managed care insurance or similar environment.
  4. Strong, demonstrated communication, analytical including critical thinking skills, problem solving and team playing skills.
  5. Ability to operate independently and in a team environment.
  6. Knowledge of Medicaid/Medicare guidelines, benefits and policies and procedures.
  7. Working knowledge of IS systems to improve operational deficiencies.
  8. Demonstrated computer skills in Microsoft Windows, Outlook, Excel, Word as well as other IS software applications.

 

 
 
 
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  • 1555 RiverCenter Drive, Suite 206
  • Milwaukee, WI 53212
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