Director Care Management, Medicaid

Working Each Day to Make a Difference

At Community Health Plan of Washington, we’re driven by our belief that everyone deserves access to quality health care.

More than 25 years ago, we made a commitment to improve the health of our communities by making quality health care accessible to all Washington state residents.

We continue that pledge today by providing affordable comprehensive coverage to more than 315,000 individuals and families throughout the state.

• We are a local not-for-profit health plan in Washington State.
• We are committed to keeping Washington families healthy.
• We connect our communities to the health resources they need.
• We provide access to high-quality care for our members.
• We connect and empower our members through technology.
• The Community Health Centers we partner with strive to support members with a comprehensive mix of medical resources in one convenient location.
• Our partnerships with Community Health Centers and our extended provider network help us improve the health care delivery system.

To learn more about how you can make a difference working at Community Health Plan of Washington, visitwww.chpw.org.

About the role:

Responsible for the direction and coordination of care management activities to manage the care of the member over the continuum of care, including both physical and behavioral health services, for assigned lines of business.  These activities include proactive identification of members in need of care management services, application of case management for identified members, care coordination and condition-specific management for certain populations with an emphasis on equity.  The focus is on supporting access to medically necessary and high quality of care and efficient utilization of available healthcare resources, facilities and services and collaboration with community programs and agencies for effective utilization of social services in the community. This role encompasses the effective and efficient management of human, fiscal and other resources, development of staff competency through assessment and education, compliance with regulatory and professional standards and strategic planning, improvement of quality, service levels, safety, customer satisfaction and of collaborative relationships within CHPW and CHNW.  

Qualifications:

Education & Prior Related Experience:

• Have a bachelor’s degree in nursing or a master’s degree in social work and/or a relevant health field, required
• Have a master’s degree in nursing, Healthcare Administration, Public Health, or Business strongly preferred
• Have a current, unrestricted license in the State of Washington as an RN required, if applicable
• Have a current, unrestricted license in the State of Washington as a Social Worker (LSWAA, LSWAIC) required, if applicable
• Have a certification as a Case Manager, required
• As this position involves traveling on behalf of the Company, a current driver’s license and an acceptable driving record is required
• A minimum of seven (7) years progressively responsible management experience in the areas of case management, population health and/or disease management required, including a minimum of five (5) years progressive experience working with medical and behavioral case management required 

Essential functions and Roles and Responsibilities: 

• Designs and implements systematic and comprehensive care management policies and procedures that ensure high quality care management application to positively impact member outcomes.
• Administers and ensures care management programs meet compliance and regulatory standards as required by Centers for Medicare & Medicaid Services (CMS), DSNP Model of Care (MOC), Washington Health Care Authority (HCA), and/or National Committee on Quality Assurance (NCQA) for continued accreditation of the health plan, as well as state and federal regulations, quality metrics and evolving models of care.
• Provides oversight of programs within assigned lines of business including development, implementation of program components, quality data collection and monitoring, auditing of program requirements and reporting outcomes to appropriate leadership and committees.
• Responsible for a strong understanding of health plan benefits for all lines of business.
• Defines strategy to identify and assess outlying and high-risk cases to determine plan of care.
• Develops and designs procedures, processes, productivity targets, quality of care and financial goals, and new delivery models for medical and behavioral health care management.
• Collaborates with Medical Directors, Healthcare Analytics, Network Management and other departments as needed to collect, analyze, and report on effectiveness of programs and address quality of care issues. Uses data to guide the development and implementation of health care interventions that improve value to the member.
• Collaborates with internal leaders to deploy a coordinated regional approach to member and provider services in each region across the state.
• Drives strategy for the development, reporting, monitoring, and analysis of department measures that are linked to organizational goals especially as pertains to achieving enrollment targets in care management programs and return on investment projections on care management programs.
• Works collaboratively with other members of the Clinical Services Leadership Team to establish mechanisms and processes to regularly analyze the different Plan populations for variances in clinical and service quality to identify and recommend the highest impact opportunities and department-level strategies for interventions.
• Delegates responsibilities to managers and provides professional development opportunities for team leaders.
• Provides leadership in developing, implementing, and communicating short and long-range plans, goals, and objectives for clinical teams. Aligns team goals with the organization’s vision and strategy.
• Evaluates and integrates Community Health Center processes and programs to ensure that resources are being maximized to improve member care and reduce duplication of work within CHPW.
• Responsible for ensuring the day-to-day supervision of divisional staff including identifying staffing and resource needs, effective hiring, appropriate performance management, staff development, with the goal of developing a cohesive, empowered, and productive work environment.
• Responsible for annual budget preparation and monitoring expenses within the department.
• Participates and/or Chairs/Co-Chairs on committees as assigned
• Employees are expected to report to work as scheduled, participate in all assigned meetings, and meet established performance and accountability standards.
• Other duties as assigned; essential functions listed are not necessarily exhaustive and may be revised by the employer, at its sole discretion. 

Employment Eligibility:

• Candidate has not been sanctioned or excluded from participation in federal or state healthcare programs by a federal or state law enforcement, regulatory, or licensing agency. 

Knowledge, Skills, and Abilities:

• Experience with designing and deploying new programs and teams.
• Demonstrated ability to effectively lead and manage large staffs, including the ability to achieve results through others.
• Experience with identifying, testing and implementing innovative concepts that support special population needs.
• Knowledge of the various components of managed care (quality improvement, disease management, population management, utilization management, and case management) and how they link.
• Actively uses and supports quality improvement principles and methods in an effort to improve inter- and intra-departmental processes.
• Strong project management skills, including the ability to implement new programs and products.
• Excellent ‘customer service’ attitude in relationships with enrollees/patients, staff and external partners.
• Highly effective communicator orally and in writing, with the ability to translate strategy into action.
• Fosters an effective work environment and ensures employees receive recognition, feedback and development.
• Ability to relate and interact with staff at all levels of the organization; exercises sound judgment, builds strong working relationships and demonstrates diplomacy, professionalism, and appropriate confidentiality in dealing with others.
• Strong analytical and problem-solving skills.
• Articulates organizational vision and implements strategic initiatives, with the ability to identify systemic issues to promote real change.
• Working knowledge of M/S office (Word, Excel, Access)
• Knowledge of regulatory and certification requirements and their impact on the organization (for example, HEDIS, CAHPS, and NCQA).
• Perform all functions of the job with accuracy, attention to detail and within established timeframes.

To apply, please visit:  https://www.chpw.org/contact-us/chpw-careers/

We're committed to our employees and their family, which is why we offer benefits that, makes a difference in their lives. Paid time off, tuition reimbursement, community service hours, and transportation perks are just a few of the offerings of our comprehensive and competitive benefits program.

Community Health Plan of Washington is an Equal Opportunity Employer with a diverse workforce!

Headquarters:              1111 3^rd Avenue, Suite 400 Seattle, WA  98101