At Doral Health & Wellness, we are proud of our commitment to our communities to provide integrated interdisciplinary health services in an innovative approach to the health and well-being of our patients. We partner with insurance companies, managed care organizations, and hospitals in the area in order to treat our patients with the highest level of care and respect. Doral Health and wellness goal is to provide clients with the highest level of service, we know that ultimately the products and services we administer serve the needs of individuals and their families.
The Director Care Management is responsible for the overall strategy, operational performance, and outcomes of the company's care management activities. This position is responsible for the oversight of the design, development, and refinement of care management and associated functions to create a continuum of integrated care and experience for our members. This position provides leadership and direction to the Care Management leadership team and is responsible for the oversight and maintenance of the program. The director collaborates across the enterprise and with clients to ensure that objectives are aligned, business strategies are delivered and financial, compliance, and quality objectives are met.
The incumbent is expected to conduct all communication and assignments professionally with peers, supervisors, subordinates, vendors, customers, and the public.
ESSENTIAL JOB FUNCTIONS:
Essential job functions include the following. Other functions may be assigned as business conditions change.
Strategic development and implementation of care management programs
Provide strategic direction, leadership, and operations oversight to programs and staff to optimize efficiency and effectiveness of Care Management operations
Collaborate with clients to perform consultative services to develop appropriate clinical coordination programs centered on supporting a member with healthcare needs.
Continually refines operational processes and leads review of team processes, workflows, and activities.
Communicates and collaborates with the senior medical director and Chief Medical Officer for medical management, clinical programs and clinical issues that arise
Direct operational readiness and regulatory/accreditation compliance via formal processes such as policy and procedure, program descriptions, auditing, training, and metric monitoring and management.
Lead the evaluation of program performance based on analysis of data and market requirements to identify and act on opportunities to enhance and improve.
Oversees the development and coordination of quarterly productivity reports and client reporting.
Create and foster an environment where the Care Management staff can work effectively and efficiently.
Leads and directs a high performing team including interviewing and hiring and onboarding of employees. Conducts performance evaluation and is responsible for managing employees, including skill and career development, policy administration, coaching on performance management and behavior, employee relations, and cost control.
Develop educational plans and implementation of annual training for skill and career development of staff
Works collaboratively with the implementation team and workflow process when adding new clients
Oversee the cost savings analysis for the Case Management and Utilization Management staff for the individual group plans.
Participate in administrative meetings & client reporting with Care Management customers, Account Representatives or other group contacts upon request as assigned by supervisor.
Performs other duties and responsibilities as assigned.
To perform this position successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions
3 years of progressive management experience, or nursing leadership role, coaching, and mentoring.
Superior facilitation, written, and oral communication skills to convey complex ideas simply, through written reports and presentation materials.
Strong leadership skills with the ability to generate ideas, support, and commitment from constituents.
Must be able to work effectively with cross-functional groups, fostering teamwork with a commitment to quality.
Strategic thinking and critical decision making at an enterprise level.
Doral Health and Wellness
Why Work Here?
Awesome CEO, great benefits and a pleasant environment.