Note: The job is a remote job and is open to candidates in USA. Healthmap Solutions is the future of specialty health management that focuses on progressive diseases, with a particular expertise in kidney health populations. The Program Director of Care Navigation Operations & Engagement is responsible for developing and executing strategies for Healthmap Care Management Programs to engage members and achieve performance targets.
Responsibilities
- Responsible for designing care management service delivery that is aligned with organizational goals for clinical, financial and experience outcomes across all Regional Pods
- Leverage payer content knowledge to ensure care teams execute against established goals across multiple payers
- Drive clinical outcomes through workflow design and content to proactively address opportunities for improvement by working with CS Ops Management
- Collaborate with the population health operations and analytics teams to execute organizational strategy and execute quality metric outcomes around the CN program objectives
- Articulate barriers and challenges across the management structure to identify solutions that contribute to the development of a sustainable platform for care management programming
- Work with CN Ops Leadership on strategic planning, program development and operations management across the regions to ensure CN model is achieving targets
- Lead the development of well-planned, well-integrated, cost-effective approaches to the case management of members. Ensure proactive intervention and targeted use of case management resources. Coordinate care effectively among all providers to ensure a seamless delivery system
- Incorporate evidence based best practice standards into program development. Research, analyze and define programs; develop the structure and key elements of the program; manage the development of new programs from concept to implementation; provide post-implementation monitoring and oversight by working with CS Ops, and cross functional departments for end-to-end alignment on program components
- Gather and document clinical and operational business requirements facilitating accurate and efficient translation to IT to establish efficient technology design and delivery
- Lead end to end Super User Acceptance Testing
- Collaborate with Reporting and Analytics team to ensure accurate capture of Client SLA documentation to achieve targets
- Collaborate with Quality and Clinical Leadership to ensure NCQA accreditation guidelines are following best in class in case management practices
- Serve as clinical case management subject matter expert for clinical program development and alignment with Member Engagement
- Collaborate with AI/ML to support Healthmap initiatives
- Monitor key performance indicators (KPIs) to assist operational performance, identify and address barriers and/or areas for improvement
- Stay updated on industry trends and best practices in healthcare operations and provide suggestions for process improvement
- Available to work outside normal business hours based on business need
- Perform other operational functions necessary for efficient and successful growth in the market
Skills
- Bachelor's degree required
- 10- 15 years' experience strategizing and implementing the design of clinical and quality activities, prior experience in healthcare required
- 10 years of progressive leadership management operations experience, preferably in a healthcare setting
- Proven history of generating superior results
- Travel to corporate headquarters as needed
- Excellent communication skills, both written and verbal, to effectively convey information to stakeholders
- Must be able to work collaboratively in a highly matrixed environment
- Strong organizational and multitasking abilities to manage competing priorities
- Proficiency in Microsoft Office Suite, including Word, Excel, PowerPoint, and Outlook
- Strong critical thinking skills to identify and resolve operational challenges
- Ability to collaborate with team members and stakeholders
- Bachelor's in Nursing or Masters preferred
Company Overview