Director, Care Management Market Liaison

Job Summary:

The Regional Director, Care Management Market Liaison works directly with leadership in assigned markets in the execution, standardization and support of the Care Management approach in collaboration with care management leadership. The Regional Director, Care Management Market Liaison supports new business readiness and implementation activities, including development of Model of Care documents for Medicare lines of business.

Essential Functions:

• Actively work with Care Management leadership in assigned markets in the ongoing oversight of operational policies, procedures and clinical content as they relate to the standardized model and regulatory and accreditation standards
• Develop the portfolio strategy to facilitate alignment across programs, coordination or deliverables and optimization of resources for new and existing markets
• Ensure that strategies are in place for ongoing risk identification, mitigation and contingency planning
• Lead in the development of processes to achieve operational excellence in all areas within the care model for care management in all supported markets
• In collaboration with care management leadership, provide strategic oversight of development and maintenance of documentation related to workflows and processes
• Oversee and control process changes that result from market level regulatory/compliance requirements to ensure alignment with the model and minimize unintended model variance within all care management teams
• Assist in determination of benchmarks, goals and outcomes for Care Management programs as well as required specialty programs associated with contractual requirements, in addition to high cost, volume and risk conditions identified through population analytics
• Oversee and manage care management policy process (end to end), ensuring effective evaluation, development, and execution/validation of all policies
• Lead the operational team to support ongoing market needs, functional areas within care management, for new and ongoing business implementation and process improvement requirements
• Participate in new business activities, including RFP, readiness and implementation activities
• Support Model of Care document development and updates for Medicare lines of business
• Perform any other job related instructions, as requested

Education and Experience:

• Bachelor’s Degree in Finance, Business, or Health Care field or equivalent years of relevant compliance, strategy or clinical implementation work experience is required
• Minimum of five (5) years of experience in health care is required in care management
• Minimum of five (5) years of clinical improvement or process redesign experience is required
• Minimum of five (5) years of management experience is required

Competencies, Knowledge and Skills:

• Proficient in Microsoft Excel, Word, PowerPoint and Excel
• Critical listening and systematic thinking skills
• Planning, problem identification and resolution skills
• Ability to maintain confidentiality and act in the company’s best interest
• Strong oral, written, and interpersonal communication skills
• Excellent leadership, management and supervisory skills and experience
• Ability to manage up to three markets and/or equivalent teams/lines of business
• Conflict resolution skills
• Knowledge of regulatory reporting and compliance requirements
• Proficiency with quality improvement, performance improvement and operations
• Demonstrated ability to develop, prioritize and accomplish goals
• Ability to work independently and within a team environment
• Strong analytic skills, with ability to derive insight from trends, processes, and outcomes
• Clinical expertise in health care services regarding disease management, clinical processes and outcomes
• Experience in a high-growth business environment 
• Working knowledge of clinical policies and procedures

Licensure and Certification:

• Current, unrestricted Registered Nurse (RN)/LCSW licensure preferred
• Case Management Certification (CCM) preferred

Working Conditions:

• General office environment; may be required to sit or stand for extended periods of time

Compensation Range:

$132,900.00 - $232,700.00

CareSource takes into consideration a combination of a candidate’s education, training, and experience as well as the position’s scope and complexity, the discretion and latitude required for the role, and other external and internal data when establishing a salary level. We are highly invested in every employee’s total well-being and offer a substantial and comprehensive total rewards