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Description
Job Description
Job Title:
Director Long Term Care RN
Job ID:
10873
Location: New York City, NY
Full/Part Time:
Full-Time
Regular/Temporary:
Regular
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Responsibilities
JOB SUMMARY:
The Director, Health Care Management Services is responsible for the development, implementation and coordination of a comprehensive health care program that will assist Health Care Management Services, Medical Management, and/or Health Plans, resulting in improved health outcomes for members.
PRIMARY RESPONSIBILITIES:
1. Assists in development and implementation of clinical programs in accordance with the goals of AMERIGROUP Corporation's mission, vision and values, the needs of the health plans, federal and state regulatory requirements and NCQA standards.
2. Serves as a clinical leader to HCMS / Medical Management associates.
3. Manages and evaluates team's performance and ensures adherence to department's standards.
4. Provides departments with updates as needed to ensure continued compliance with specific medical management standards
5. Assists in the development of medical management policy, procedures and guidelines that relate to specific programs.
6. Assists in evaluating and implementing contracts in coordination with Network Development as needed to implement specific programs.
7. Assists Member Services and Provider Inquiry Department with timely response to issues including complaint resolution.
8. Assists in developing clinical management guidelines including:
Conducting literature search to identify evidenced-based management
Identifying changes in practice which may require updating of guidelines
Developing DRAFT guidelines as directed
Identifying national providers experienced in treating patients within these areas
Coordinating physician advisory groups
9. Assists in managing the information requirements of HCMS / Medical Management programs.
10. Acquires data and evaluates necessary medical, mental health and substance abuse services for cost containment.
11. Identification and implementation of HCMS/ Medical Management best practices.
12. Ensures that delegated medical management activities are contracted, reviewed and reported according to established criteria.
13. Evaluates programs quarterly.
14. Supports and participates in quality initiatives and activities including clinical indicators reporting, focus studies and HEDIS reporting.
15. Ensures compliance with state reporting on utilization management activities for accuracy.
16. May assist in developing the annual operating and capital budgets to sufficiently meet departmental needs.
17. Other duties as requested or assigned.
EDUCATION AND EXPERIENCE:
Education
Required: Bachelors Degree
Preferred: MSN, MPH, MPA, or MSW or related or MBA with Health Care Concentration
Years and Type of Experience Required:
Required:
Must have five years management experience.
Must have at least five years of current experience in utilization management in a managed care setting.
Knowledge and Technical Skills
Required:
Demonstrated medical management experience in health care.
Knowledge of Utilization Management targets
Self-directed with strong organizational skills.
Excellent verbal and written communication skills.
Ability to foster inter and intradepartmental communication and team building.
Strong analytical capabilities.
Attention to detail.
Mastery of computer software.
Statistical reporting experience preferred.
Multi-task oriented with ability to follow-up on numerous complex problems.
Strong customer focus.
Certifications or Licensure
Required: RN or LCSW , LPC
Preferred: Certified Case Manager
SCOPE INFORMATION
Item Measure
# Direct Reports 2-10
# Indirect Reports 2-20
Budgetary $ Responsibility As assigned
PHYSICAL REQUIREMENTS
Able to operate a computer
Able to operate a telephone
Must be able to travel on common carriers and to adhere to AMERIGROUP's travel policies.
Equal Employment Opportunity
In accordance with state and federal laws, employment offers are tendered solely on the basis of qualifications without regard to race, religion, color, national origin, age, sex, marital status, sexual orientation, handicap (including disabled veterans) or Vietnam Era veteran status.
AMERIGROUP administers pre-employment drug testing as a condition of employment and a satisfactory criminal history background report.
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Details:
Job Id:
692313A3
Posted / Updated:
3/30/2010 3:32:04 AM
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