Healthy Connections Director of Care Management

Job Description:

Select Health is a community health plan serving more than 1 million members. Select Health’s line of businesses include Medicare, Medicaid, FEHB, Marketplace Qualified Health Plans, and fully funded and self-funded Commercial Employer plans.

This leader is responsible for the development, implementation, evaluation, and operational management of care management programs for the line of business(s) which this position oversees. The position requires an understanding of care management industry benchmarks, best practices and regulatory environment for the line of business function.

This position leads a team of five managers, and associated frontline caregivers, and strategy as assigned to this role.

The role is hybrid and will require travel as needed, primarily to areas where Select Health conduct business. We will consider candidates who live in, or are willing to relocate to, Utah, Idaho, Nevada, Colorado and are within a reasonable commuting distance to a Select Health care site.​ Currently, we are not hiring remote workers in the following states: CA, CT, HI, IL, NY, RI, VT, and WA.

Essential Functions

• Supports development and refinement of tools, processes and systems to optimize medical management, clinical outcomes and member satisfaction in order to provide a seamless experience for our members as they cross the full continuum of their healthcare journey. 
• Oversees program components related to care management and utilization review for the specific line of business, across all service areas and multiple states and assists the department leader in scaling care management and utilization review operations that supports membership growth, acquisitions and expansion into new service areas in a strategic and efficient way.
• Ensures Select Health offers competitive programs, monitors medical expense trends for the product line and works with senior leadership to evaluate or add programs to impact trends. 
• Uses a data-driven approach to assess utilization management and care management operations and make program recommendations.
• For Interdisciplinary Care Management, develops structures and processes to facilitate care coordination among treating physicians, pharmacists, behavior health professionals, and other treating providers in multidisciplinary care planning and care delivery.
• Collaborates with our network partners through joint operating committees to assure program development and integration and coordinates activities across department lines to meet operational objectives of Select Health.
• Oversees strategic planning, day-to-day operations, and standards of care. Promotes efficient, fiscally responsible, effective, safe, and compassionate care.
• Accountable for fiscal management, including budget development, cost center analysis, and ongoing monitoring to ensure
• alignment with organizational goals.
• Models professionalism and fosters a supportive environment. Leads workforce planning efforts focused on recruitment,
• retention, staffing, development, and succession planning.
• Oversees human resource functions including interviewing, hiring, onboarding, training, and performance management which
• may include corrective action and termination.
• Facilitates coordinated clinical and non-clinical care in collaboration with interdisciplinary teams and providers to enhance
• patient outcomes.
• Partners with physicians to achieve clinical, operational, financial, and service excellence.
• Ensures processes and programs support patient satisfaction and service quality goals.
• Builds community relationships and promotes the integration of community resources to enhance the overall patient
• experience.
• Ensures compliance with regulatory agencies regarding discharge planning, conditions of participation and care

Skills

• Leadership
• Communication
• Health plan functions
• Care management
• Performance management
• Change management

Qualifications

Minimum Qualifications

• Bachelor's or master’s degree in clinical specialty, such as Nurse, LCSW, Nurse Practitioner, Physician's Assistant, Physical or Occupational Therapy. Education is verified.
• Current associated clinical license in state of Utah and other states where Select Health does business
• Experience working in a managed care environment and have familiarity with the regulatory environment pertinent to the Line of Business (LOB) they will oversee (e.g. NCQA, CMS).
• Th