Director, Women and Children's Health(Must Live In Ohio & Preferred Experience In Managed Care)

Job Summary:

Director, Women and Children's Health is responsible to collaborate with enterprise and market leadership in the development, design and implementation of women and children’s health program, aligning to market requirements, corporate goals, and quality outcomes.

Essential Functions:

• Serve as subject matter expert (SME), for women and children’s health in data analysis, staffing implications and performance goals associated the population
• Lead large scale transformational change in the market, working effectively with all levels of the organization, individual and team, across disciplines and geography
• Identify, forge, and sustain provider partner relationships to facilitate access, address barriers to care and improve coordination that support decreased duplication and improved healthcare outcomes
• Identify, forge and sustain community resource/service agency partnerships to ensure a community based, collaborative approach to our members' care, resulting in leveraging existing resources to decrease waste and improve member outcomes
• Development of strategy to include health partners, school-based health clinics and community partners to drive access and quality care of women and children
• Monitor performance across programs to identify improvement opportunities, leverage best practice and knowledge sharing for the purpose of improving outcomes through the standardization of evidence-based practices
• In collaboration with Consumer Experience Team, monitor and analyze member satisfaction surveys to identify and develop appropriate activities as needed
• In collaboration with market Quality team, conduct a program evaluation annually outlining the effectiveness of the Women and Children’s Health Program plan
• Develops strategies in collaboration with Regional Care4U and Quality to drive initiatives to achieve quality goals.
• In collaboration with market leadership and quality Identity’s benchmarks, goals and outcomes for maternal-child program
• Leads a continuous improvement of the CareSource Women and Children’s Health Outcomes Case/Care Management process by developing and disseminating best practices throughout Care4U.
• Participates in internal workgroups/committees to improve quality measures, accreditation, and clinical monitoring outcomes
• Collaborates with Enterprise, Quality, Operations, and Information Technology departments to ensure full integration of Women and Children’s Health Outcomes program initiatives and operations
• Monitor and ensure the execution of the Women and Children’s Health plan is meeting or exceeding all appropriate requirements established by Federal, State and Accrediting bodies.
• Participates in national and/or state maternal-child committees and focus groups specific to maternal-child and provides input on behalf of CareSource regarding any suggested revision(s)
• Establishes budget and monitors for adherence in conjunction with Senior Management. Links budgetary expenses to define improvements in member health and/or cost savings. .
• In collaboration with Market Care4U and Quality leadership, establishes and maintains standards and procedures for accreditation and quality reporting and documentation and communicates areas of strengths as well as opportunities for improvement to the Quality Management and Improvement Committee
• Participates in site visit preparation and execution by regulatory and accreditation agencies (state agencies, URAC,NCQA,CMS,AAAHC,EQRO)
• Manages and develops direct reports who include other management or supervisory personnel and/or staff who have clinical expertise and are trained in Women and Children’s Health
• Participate and represent CareSource externally with speaking engagements, State and regional committee work as needed
• Leads by example and “inspects” behavior to ensure that every interaction with our members supports the member to feel informed, empowered, and supported by CareSource
• Perform any other job duties as requested

Education and Experience:

• Bachelor’s degree in nursing, management, healthcare management or related field or equivalent years of relevant experience is required
• Master’s degree in nursing, business, healthcare management or associated field is preferred
• A minimum of ten (10) years of clinical experience in healthcare delivery is required
• A minimum of five (5) years of leadership/management experience is required
• Managed Care experience is preferred
• Maternal/child health nursing care or program development experience is preferred
• Medicaid experience is preferred

Competencies, Knowledge and Skills:

• Intermediate proficiency level with Microsoft