Director Care Management
About UsAkron Children's Hospital is one of the largest independent pediatric hospitals in the U.
S.
, and ranked among the best children's hospitals by U.
S.
News and World Report.
Our dedicated staff serves nearly 900,000 patient visits per year through our 2 hospital campuses and a large network of locations offering primary and specialty care.
We are leading the way to healthier futures for children and communities through expert medical care, research, and prevention and wellness programs.
As a teaching affiliate of Northeast Ohio Medical University and other universities, we train new generations of pediatricians, specialists, nurses and pharmacists every year.
OUR PROMISESTo treat every child as we would our ownTo treat others as they would like to be treatedTo turn no child away for any reasonWe are seeking people who are committed to fostering a diverse environment in which patients, family and staff from a variety of backgrounds, cultures, and personal experiences are welcomed, included and can thrive.
Summary:
Akron Children's Health Collaborative (ACHC) is a newly established 501c4 organization built to improve child health through collaboration with community physicians and contracting with Managed Care Organizations (MCOs).
The role of Director of Care Management will directly report to the leader of ACHC with a matrix relationship to the Vice President of Population Health at Akron Children's Hospital.
The Director of Care Management is responsible for the development, implementation, measurement, refinement, ongoing quality improvement and effectiveness of the ambulatory care management program and to work collaboratively across the care coordination continuum.
Effectively leads diverse clinical teams and exceeds delegation (if applicable) and regulatory expectations for populations assigned.
Accountable to ensure effective cross-collaboration for activities that ensure optimal population health management, alignment with emerging healthcare payment contracts, and reduction in overall medical expenses, while also maintaining and improving the quality and effectiveness of care.
This position requires sustained awareness to medical management results, industry trends, and operational conditions.
Must have ability to prepare for and react to industry trends in an organized and supported manner key to meeting organizational goals.
Responsibilities:
Executes the day-to-day delivery and operational oversight of all clinical care coordination/ care management programs for the organization.
Acts as a champion for the dissemination of the care management program throughout the organization.
Ensures the functioning of care coordination activities across the continuum of care (assessing, planning, implementing, coordinating, monitoring, and evaluating), including access to primary care, behavioral health, and coordination of health care services for all members.
Implements mechanisms for identifying, assessing, and developing treatment plans for members with special health care needs.
Develops and implements processes and resources for providing support to members who opt out of care coordination.
Serves as the primary point of contact for state driven care coordination.
Coordinates services furnished to the member with the services the member receives from any other health care entity.
Ensures care coordination and disease management is part of population health and quality improvement activities, when appropriate.
Works closely with the executive and Care Management leadership, external committee attendees, and others to evaluate the effectiveness of the Care Management Program.
Assures alignment between clinical management programs and any related medical practice guidelines.
Ensures that clinical guidelines are current, valid, and communicated to providers as appropriate.
Implements, manages, and works collaboratively through the NCQA accreditation process, when applicable, to ensure that the Care Management / Case Management / Care Coordination policies and procedures meet regulatory and accreditation requirements and that population health management delegation is maintained.
Directs the gathering, evaluation, and management of statistical and quantitative data supporting managed care outcomes, care management performance, quality, and overall program effectiveness in accordance with organizational standards and any other applicable standards and regulations, including recommendations on monthly financial reports to validate and account for variances and the annual operating budget for approval.
Identifies and evaluates potential new programs and services to determine cost-effectiveness and revenue potential.
Provides routine reports on interventions and outcomes of the program.
Develops and monitors goals and milestones designed to further the success of the Care Management Program within the framework of the organization's annual goals.
Works collaboratively with other departments to integrate care management initiatives and goals with organizational programs.
Collaborates with internal and external entities to improve accessibility standards and quality practice standards to reduce medical costs across the service delivery system (inpatient, emergency departments, urgent care services, and practitioner office settings).
Works collaboratively with related functional departments (inpatient care coordination, population health, etc.
) to design a baseline quantitative analysis of care management program membership.
Formulates measurable program goals based on quantitative analysis.
Utilizes timely and meaningful financial and utilization reports to assist providers in efforts to alter their care delivery patterns and improve member outcomes.
Exceptional analytic and problem-solving skills, communication skills, physician and vendor relations skills and a true passion for working with physicians.
Other information:
Technical Expertise Experience with managed care data systems and reporting.
Proficiency in various word processing, spreadsheet, graphics, and database programs, including Microsoft Word, Excel, Access, PowerPoint, Outlook, etc.
Education and Experience Master's degree in Nursing Minimum
Experience:
5 years of experience with care management.
5 years of experience in the development and execution of clinical programs.
5 years of advanced levels of staff management and leadership experience.
Must have health plan / payer experience.
Demonstrated ability to assist with focusing activities toward a strategic direction as well as develop tactical plans, drive performance, and achieve targets.
Problem-solving skills:
the ability to systematically analyze problems, draw relevant conclusions, and devise appropriate courses of action.
Preferred
Experience:
5 years of leadership and strategy related-work in case management, quality management, and compliance management.
Expertise in regulatory and accreditation standards (e.
g.
, NCQA, CMS, etc.
).
Experience with the pediatric population.
Required Certification/Licensure:
Current unrestricted license as a Registered Nurse in Ohio.
Preferred Certification/Licensure:
Certified Case Manager from the Commission for Case Manager Certification, nurse leader certification, and/or healthcare leadership recognition.
Full Time FTE:
1.
000000Akron Children's Hospital is an Equal Opportunity Employer of Minorities, Females, Protected Veterans, and Individual with Disabilities.
EEO is the law, please click/copy paste the link below to learn more:
https:
//www.
eeoc.
gov/sites/default/files/migrated_files/employers/eeoc_self_print_poster.
pdfPosition:
ADMINISTRATIVESalary:
$25.
55 - $32.
57.
Estimated Salary: $20 to $28 per hour based on qualifications.
S.
, and ranked among the best children's hospitals by U.
S.
News and World Report.
Our dedicated staff serves nearly 900,000 patient visits per year through our 2 hospital campuses and a large network of locations offering primary and specialty care.
We are leading the way to healthier futures for children and communities through expert medical care, research, and prevention and wellness programs.
As a teaching affiliate of Northeast Ohio Medical University and other universities, we train new generations of pediatricians, specialists, nurses and pharmacists every year.
OUR PROMISESTo treat every child as we would our ownTo treat others as they would like to be treatedTo turn no child away for any reasonWe are seeking people who are committed to fostering a diverse environment in which patients, family and staff from a variety of backgrounds, cultures, and personal experiences are welcomed, included and can thrive.
Summary:
Akron Children's Health Collaborative (ACHC) is a newly established 501c4 organization built to improve child health through collaboration with community physicians and contracting with Managed Care Organizations (MCOs).
The role of Director of Care Management will directly report to the leader of ACHC with a matrix relationship to the Vice President of Population Health at Akron Children's Hospital.
The Director of Care Management is responsible for the development, implementation, measurement, refinement, ongoing quality improvement and effectiveness of the ambulatory care management program and to work collaboratively across the care coordination continuum.
Effectively leads diverse clinical teams and exceeds delegation (if applicable) and regulatory expectations for populations assigned.
Accountable to ensure effective cross-collaboration for activities that ensure optimal population health management, alignment with emerging healthcare payment contracts, and reduction in overall medical expenses, while also maintaining and improving the quality and effectiveness of care.
This position requires sustained awareness to medical management results, industry trends, and operational conditions.
Must have ability to prepare for and react to industry trends in an organized and supported manner key to meeting organizational goals.
Responsibilities:
Executes the day-to-day delivery and operational oversight of all clinical care coordination/ care management programs for the organization.
Acts as a champion for the dissemination of the care management program throughout the organization.
Ensures the functioning of care coordination activities across the continuum of care (assessing, planning, implementing, coordinating, monitoring, and evaluating), including access to primary care, behavioral health, and coordination of health care services for all members.
Implements mechanisms for identifying, assessing, and developing treatment plans for members with special health care needs.
Develops and implements processes and resources for providing support to members who opt out of care coordination.
Serves as the primary point of contact for state driven care coordination.
Coordinates services furnished to the member with the services the member receives from any other health care entity.
Ensures care coordination and disease management is part of population health and quality improvement activities, when appropriate.
Works closely with the executive and Care Management leadership, external committee attendees, and others to evaluate the effectiveness of the Care Management Program.
Assures alignment between clinical management programs and any related medical practice guidelines.
Ensures that clinical guidelines are current, valid, and communicated to providers as appropriate.
Implements, manages, and works collaboratively through the NCQA accreditation process, when applicable, to ensure that the Care Management / Case Management / Care Coordination policies and procedures meet regulatory and accreditation requirements and that population health management delegation is maintained.
Directs the gathering, evaluation, and management of statistical and quantitative data supporting managed care outcomes, care management performance, quality, and overall program effectiveness in accordance with organizational standards and any other applicable standards and regulations, including recommendations on monthly financial reports to validate and account for variances and the annual operating budget for approval.
Identifies and evaluates potential new programs and services to determine cost-effectiveness and revenue potential.
Provides routine reports on interventions and outcomes of the program.
Develops and monitors goals and milestones designed to further the success of the Care Management Program within the framework of the organization's annual goals.
Works collaboratively with other departments to integrate care management initiatives and goals with organizational programs.
Collaborates with internal and external entities to improve accessibility standards and quality practice standards to reduce medical costs across the service delivery system (inpatient, emergency departments, urgent care services, and practitioner office settings).
Works collaboratively with related functional departments (inpatient care coordination, population health, etc.
) to design a baseline quantitative analysis of care management program membership.
Formulates measurable program goals based on quantitative analysis.
Utilizes timely and meaningful financial and utilization reports to assist providers in efforts to alter their care delivery patterns and improve member outcomes.
Exceptional analytic and problem-solving skills, communication skills, physician and vendor relations skills and a true passion for working with physicians.
Other information:
Technical Expertise Experience with managed care data systems and reporting.
Proficiency in various word processing, spreadsheet, graphics, and database programs, including Microsoft Word, Excel, Access, PowerPoint, Outlook, etc.
Education and Experience Master's degree in Nursing Minimum
Experience:
5 years of experience with care management.
5 years of experience in the development and execution of clinical programs.
5 years of advanced levels of staff management and leadership experience.
Must have health plan / payer experience.
Demonstrated ability to assist with focusing activities toward a strategic direction as well as develop tactical plans, drive performance, and achieve targets.
Problem-solving skills:
the ability to systematically analyze problems, draw relevant conclusions, and devise appropriate courses of action.
Preferred
Experience:
5 years of leadership and strategy related-work in case management, quality management, and compliance management.
Expertise in regulatory and accreditation standards (e.
g.
, NCQA, CMS, etc.
).
Experience with the pediatric population.
Required Certification/Licensure:
Current unrestricted license as a Registered Nurse in Ohio.
Preferred Certification/Licensure:
Certified Case Manager from the Commission for Case Manager Certification, nurse leader certification, and/or healthcare leadership recognition.
Full Time FTE:
1.
000000Akron Children's Hospital is an Equal Opportunity Employer of Minorities, Females, Protected Veterans, and Individual with Disabilities.
EEO is the law, please click/copy paste the link below to learn more:
https:
//www.
eeoc.
gov/sites/default/files/migrated_files/employers/eeoc_self_print_poster.
pdfPosition:
ADMINISTRATIVESalary:
$25.
55 - $32.
57.
Estimated Salary: $20 to $28 per hour based on qualifications.
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