Director, Care Management Organization
Directs and oversees the implementation of VNSNY Population Health’s care management solution in collaboration with senior leadership, which includes defining infrastructure, establishing business processes, and identifying evidence-based clinical best practices and appropriate utilization management across the care continuum in both inpatient and outpatient settings. Works under general direction.
Leads and oversees the care management solution and any change processes required to implement the new and ongoing revisions to models of care management, including, but is not limited to, implementation of role changes and infrastructure changes, plans for new skills acquisition, expanded relationships with community resources, creating alternatives to emergent and inpatient care and improvement in capacity management.
Collaborates with Population Health leadership to define Care Management Organization (CMO) financial, quality and performance targets to ensure alignment with VNSNY strategic goals. Accountable for metrics and financial performance of care management solution in accordance with customer contracts.
Creates data priorities and establishes dashboards for monitoring outcomes.
Designs, implements and evaluates staffing coverage based on established case management ratios to serve population needs, volume and acuity of patients/members, and populations according to various customers and products.
Develops infrastructure and processes that facilitate optimal assignment of responsibilities to the interdisciplinary team members that contribute to continuity of care through demonstrated use of evidence based practice resource alignment. Collaborates with internal and external resources, agencies, physicians and members of the inter-professional provider teams in meeting customer needs and organizational goals.
Ensures compliance with all regulatory issues and standards of practice.
Collaborates with Clinical Education to identify training needs and activities for staff that focus on accurate and appropriate evidence based practice principles, existing tools and guidelines, and guideline software applications.
Collaborates with Clinical Education on “train the trainer” programs to ensure standardized training for new and incumbent staff.
Researches literature with team around emerging evidenced based practice guidelines for service level approvals and authorizations and guidance to clinicians.
Ensures that technology and software systems support workflows with clinical and business logic, standards of practice and regulatory and accreditation requirements.
Collaborates with Quality Management to evaluate the effectiveness of workflows and targeted training for clinical utilization. Makes recommendations for changes/improvements as needed.
Oversees program to ensure successful patients/members transfers through multiple care transitions by coordinating necessary physician’s instructions/communications, medical equipment, medication needs and all other required documentation.
Participates in special projects and performs other duties as assigned.