Job title: Director of Clinical Care Management / HIV / Hybrid
Company: RCM Health Care Services
Job description: For more than 30 years, this health plan has been committed to building strong relationships with its members and providers to enable New Yorkers to live their healthiest life. They provide the highest quality healthcare services to residents of Bronx, Brooklyn, Manhattan, Queens, and Staten Island through a comprehensive list of products.Director of Care Management / PIC / Partnership in Care / Hybrid
Hybrid position (requiring 2 days in the Manhattan office and 3 days remote)
Position Overview
Under the direction of the Medical Director for Partnership in Care (PIC), the Director of Care Management (PIC) provides clinical and administrative direction to Partnership in Care care management staff who are focused on providing high quality clinical support and health education to members with HIV and those at risk of HIV infection to ensure these members receive the best possible care and achieve optimal health and wellness. The Director of Care Management (PIC) coordinates program functions across Medical Management, Operations, Finance, and Call Center Departments.
Job Description
- Supervise and provide clinical and administrative oversight to Partnership in Care staff involved in care management activities.
- Promote and facilitate a multidisciplinary, data-driven approach to coordination of care and plan operations among disciplines.
- Ensure that standards of HIV care and chronic care delivery models and standards for Plan operations are consistent with the organization’s model of care, current professional standards, prevailing evidence-based practices, compliant with Federal, State and City regulations, and consistent with the mission, vision and values of the organization.
- Lead interdisciplinary care rounds and conduct regular case reviews with care management staff of complex and/or high acuity cases. Lead engagement with clinical facilities and providers to optimize the management of members with complex care needs.
- In collaboration with the Director of Community Outreach, Quality and Compliance, provide oversight and supervision of Partnership in Care program staff in the planning, development, implementation, and evaluation of quality improvement initiatives within the Partnership in Care program and within the Division of Medical Management.
- Ensure staff are fully trained and adherent to established documentation standards.
- In collaboration with the Director of Community Outreach, Quality and Compliance, contribute to the development and maintenance of an effective evaluation and monitoring system and utilize a variety of reports for staff coaching and program improvement.
- Collaborate with other organizational departments responsible for functional aspects of the HIV Special Needs Plan, including, but not limited to Integrated Care Management, Behavioral Health, Managed Long-Term Care, Utilization Management, Quality Management, Credentialing, Regulatory Affairs, Compliance, Corporate Affairs, Provider Network Operations, Medicare Services, Information Systems, Finance, Claims, and Member Services and Eligibility.
Minimum Qualifications
- Bachelor’s Degree from an accredited college or university is required. Master’s Degree from an accredited college or university in Nursing, Social Work, or other healthcare-related discipline is preferred.
- A minimum of five years of progressive, professional experience in Nursing, Social Work, Health Care Administration, or other healthcare-related experience.
- A minimum of five years of administrative experience including supervision of staff from diverse professional backgrounds.
- Experience and knowledge of Managed Care, Case Management, and HIV care strongly preferred.
- Experience with developing and delivering staff training and in-services preferred.
- Bilingual (English/Spanish) preferred.
Licensure and/or Certification Required:
- New York State licensure as a Registered Professional Nurse, Nurse Practitioner, Physician Assistant, or Social Worker
Salary is $155,000 with excellent benefits (Pension Plan)
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Expected salary: $155000 per year
Location: New York City, NY
Job date: Fri, 30 Aug 2024 22:33:46 GMT
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