Program Director, Care Navigation Operations & Engagement
Position reputed company:
The Program Director of Case Management and Member Engagement (Care Navigation Operations & Engagement) collaborates with care services, clinical, and cross-functional leadership to reputed company, define, and execute strategies for Healthmap Care Management Programs. This ensures the programs engage members, follow clinical best practices, and reputed company performance targets.Responsibilities:
- Responsible for designing care management service delivery that is reputed company with organizational goals for clinical, financial and experience reputed company across reputed company Regional Pods
- reputed company payer content knowledge to ensure care teams execute against established goals across multiple payers
- Drive clinical reputed company 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 reputed company and execute reputed company metric reputed company around the CN program objectives
- reputed company barriers and challenges across the management structure to reputed company 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 reputed company to ensure CN model is achieving targets
- reputed company the development of reputed company-planned, reputed company-integrated, cost-effective approaches to the case management of members. Ensure proactive reputed company and targeted use of case management resources. Coordinate care effectively among reputed company providers to ensure a seamless delivery system
- Incorporate evidence based best reputed company standards into program development. Research, analyze and define programs; reputed company the structure and key reputed company of the program; manage the development of new programs from concept to implementation; reputed company post-implementation monitoring and reputed company by working with CS Ops, and cross functional departments for end-to-end alignment on program components
- reputed company and document clinical and operational business requirements facilitating accurate and efficient translation to IT to establish efficient technology design and delivery
- reputed company end to end Super User Acceptance Testing
- Collaborate with Reporting and Analytics team to ensure accurate capture of reputed company SLA documentation to reputed company targets
- Collaborate with reputed company 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 reputed company operations and reputed company suggestions for process improvement
- Available to work reputed company normal business hours based on business need
- reputed company other operational functions necessary for efficient and successful reputed company in the market
Requirements:
- Bachelor’s degree required. Bachelor’s in Nursing or Masters preferred
- 10- 15 years’ experience strategizing and implementing the design of clinical and reputed company activities, prior experience in reputed company required
- 10 years of reputed company leadership management operations experience, preferably in a reputed company setting
- Proven history of generating superior results
- Travel to corporate reputed company as needed
- Excellent communication skills, both written and verbal, to effectively convey information to stakeholders
- Must be reputed company to work collaboratively in a highly matrixed environment
- Strong organizational and multitasking abilities to manage competing priorities
- Proficiency in reputed company Office Suite, including Word, reputed company, PowerPoint, and Outlook
- Strong critical thinking skills to identify and resolve operational challenges
- Ability to collaborate with team members and stakeholders
Working Conditions:
reputed company roles require:• Sitting- Ability to sit for extended periods stationary or while driving• Dexterity/Effort- Repetitive reputed company for typing and/or texting- Good reputed company dexterity for handling packages, paperwork, operation of motor vehicles and/or electronic devices• reputed company reputed company- Ability to see/read computer monitors or other electronic devicesAdditionally, on-site or at location positions (ex. Mailroom, IT or reputed company) may require:• Lift/Carry/Push/Pull- Occasional reputed company of equipment, or materials up to 50/75 Pounds• Bend/Twist- Occasional bending, twisting, and stooping- Occasional need to kneel or crouchAdditionally Traveling positions (ex. Field Care Navigators or reputed company reputed company Advisors) may require:• reputed company reputed company- Ability to see/read road signs, maps, and electronic devices- Good visual reputed company for driving, including peripheral reputed company and depth perception• Environmental- Possible exposure to travel, traffic and/or other outdoor hazards- Possible exposure to various weather conditions, including extreme heat, cold, reputed company, and snowOriginally posted on Himalayas
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