Job Description :
We are looking for Director for Complex Care in New York, NY.



JOB DESCRIPTION

Job Title: Director of Complex Care

Department: Complex Care

Location: New York, NY

Duration- Full Time





JOB SUMMARY:



The Director of Complex Care oversees Medicare and Medicaid-Medicare programs including Medicaid Advantage Plus (MAP), Fully Integrated Duals Advantage (FIDA), Medicare Advantage Prescription Drug plan (MAPD), Dual Eligible Special Needs Plans (D-SNP The Director of Complex Care will be responsible for ensuring appropriate Care Management operations by overseeing a team consisting of Clinical Team Manager, Care Managers, Social Workers and Care Coordinators. This role also includes collaborating and communicating with various departments to ensure appropriateness in delivery of care, accuracy in data, quality improvement, and to deliver optimal quality of care to members.





PRIMARY RESPONSIBILITIES:



Plan, direct, and lead all activities of the Medicare and Medicaid-Medicare programs, including oversight of the Complex Care Department which includes Complex Care Managers, Complex Care Social Workers, Complex Care Coordinators, and other Complex Care staffs.


Screen, interview and hire clinical team employees, anticipating growth and training


Monitor, develop, and recommend changes in operational procedures, including workflows, policies and procedures that promote quality person-centered care for members, monitor productivity and risk management, cost-effectiveness, staff engagement, performance, and satisfaction


Identify educational needs and learning styles to develop care management tools through collaboration with various operational staff, including Information Systems department and Clinical Operations department


Collaborate with Quality Management and Care Management to implement effective methods to optimize access to preventive care screenings and disease management for members. This includes monitoring the effectiveness in capturing HEDIS data sets, identifying barriers and solutions to the barriers


Participates in departmental audits conducted by CPHL internally, Department of Health, Centers for Medicaid and Medicare, and other entities.


Participate and lead clinical rounds or case conferences as needed and provide clinical solutions that may include but not limited to: access to care for members, discharge planning, member education, coordination of care


Actively work with Utilization Management Department to ensure that the member has a needs-based level of services are available and delivered in a timely, cost-effective manner based upon any relevant change in member’s condition


Work with senior management and leadership to develop models of care, identify issues and develop solutions for the Medicaid-Medicare and Medicare programs


Assure Complex Care Department’s activities remain compliant with all regulatory, contractual, and internal standards and requirements


Works flexible schedule as necessary and other duties as assigned


EDUCATION AND EXPERIENCE:



Type of Experience:

· Knowledge of community long-term care, current community health practices for the frail adult population, appropriate support services in the community

· Knowledge of Medicaid-Medicare and Medicare programs

· Clinical experience with experience in staff supervision and program management

Experience working within community-based home health organizations
Experience working within a managed care environment


Required:

Bachelor of Science in Nursing

Active and unrestricted NYS RN license

Knowledge of UAS-NY assessment

Computer proficiency

Strong written and verbal communication skills

Proficient in the use of Microsoft office Suite tools, including Word, PowerPoint, Excel