Sr Dir, Field Care Management

Tampa, FL 33607

Posted: 07/12/2019 Category: Healthcare Job Number: 29784

Job Title:  Sr Director, Field Care Management – Registered Nurse

Location:  Tampa FL 33607

SHIFT:        Mon – Fri 8-5

PAY:           $165, 000 annually

Contact me directing  if interested  in this position, call, text or email.  Drita Berishaj (Staffing Manager) 586-710-7957 or dberishaj@alinestaffing.com

Description: Licensed RN will be supporting CMS.  Develops core curriculum plans, assigns resources and direct activities for the Case Management program enterprise wide. Assesses the effectiveness of programs in achieving enterprise goals with focus on cost-effective improvement in quality of care for members. Oversee productivity of Case Management associates and drive results and outcomes of the Case Management programs.
  • Researches, interprets and integrates pertinent medical literature to develop cost effective Case Management programs with measurable results.
  • Plans, conducts and directs work on complex projects/programs necessitating the origination and application of new and unique approaches.  
  • Communicates with management at the highest level to ensure adequate budgetary allocation of staff and other resources.
  • Communicates with external customers including but not limited to Federal and State Program Directors, legislators, government executives and physician partners.
  • Establishes budget, obtains approval from senior management and monitor for adherence.
  • Links budgetary expenses to define improvements in member health and/or cost savings.
  • Ensures corporate initiatives are implemented to achieve optimum results.
  • Manages and develops direct reports who include other management or supervisory personnel and/or individual case managers who have clinical expertise and are trained in Case Management activities.
  • Directs the review of assessments by nurse managers and provides advice in regard to complex, controversial or unique administrative processes, medical procedures and payment guidelines.
  • Develops strategies and ensures maximum efficiencies in the utilization of human and financial resources.
  • Sets operational priorities and manages resources to operational goals and budgets.
  • Establishes professional working relationships with all providers towards the end goal of establishing a care continuum for the members.
  • Leads a continuous improvement of the WellCare Case Management process by developing and disseminating best practices throughout the enterprise.
  • Educates WellCare departments on the Case Management Programs, especially in regard to identification of potential cases.
  • Maintain collaboration with Inpatient Services, Outpatient Services, Pharmacy, Customer Services and Quality Improvement to ensure early identification of members in need of Case Management.
  • Ensures compliance with all state and federal regulations and guidelines for all lines of business in all States.  
  • Works with Medical Directors to tap their expertise in the management of members.
  • Responsible for oversight of the design of non-existing medical management programs, such as for the ID/DD population.
  • Responsible for oversight of the Medical Management’ s contributions to RFP’ s, RFI’ s and implementation of Medical Management for new lines of business either at corporate or in the markets.

Requirements:
  • A Bachelor' s Degree in Nursing or Health Administration Required
  • A Master' s Degree in Business Administration, Public Health, Health Administration or related field Preferred Experience Level Experience Details
  • 10+ years of experience in Case management, Utilization management, or Quality improvement
  • 10+ years of experience in Managed care insurance industry
  • 5+ years of experience in Medicare, Medicaid, and RFI (Request for Information)
  • 5+ years of management experience
  • Licensed Registered Nurse (RN) Required Other Certification in project management, Quality improvement, or CCM Preferred Skill Sets Other Skills Proficiency
  • Ability to recognize and implement areas for process improvements Advanced Other Advanced ability as a licensed professional to communicate on any level required to meet the demands of the position.
  • Advanced Ability to review and interpret contracts
  • Advanced Other Ability to lead a cross functional team with strong people leadership skills
  • Advanced Ability to work within tight time frames  and meet strict deadlines
  • Advanced Technology Microsoft Excel Intermediate Required Microsoft Word Intermediate Required Microsoft Outlook Intermediate Required Healthcare Management Systems (Generic)
  • Intermediate Required Level of Supervision Exercised: (Select all that apply) Positions Supervised This position manages people # Direct Reports 6-20 # Indirect Reports 50-100 X Sr. Management / Directors X Managers/Supervisors X Exempt level associates / Team Leaders X Nonexempt level associates


WE OFFER:
  • Full benefits available after 90 days: Medical, Dental, Vision, Life, Short-term Disability
  • 401k after 1 year of employment: With employer match and profit sharing
  • Wellness Program: Now including FITNESS benefits!
  • Competitive Pay Rate!
  • Work Life Balance
Contact me directing if interested in this position, call, text or email. Drita Berishaj (Staffing Manager) 586-710-7957 or dberishaj@alinestaffing.com

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