Alliance Health

Compensation

Full Description

The Sr Director-Physical Health is a senior leadership role responsible for the strategy, oversight and performance of the physical health care management programs. This position ensures that care management services deliver high quality, cost-effective care, improve health outcomes, and adhere to state and federal regulations, payer contracts, and internal policies and procedures. Reporting to SVP-Care Management, this position will participate in strategic planning as a member of the Clinical Operations senior leadership team. This position will allow the successful candidate to work a schedule that will be primarily remote. While there is no expectation of being in the office routinely, they will be required to report to the Alliance Home Office (Morrisville, North Carolina) for business meetings as required. Responsibilities & Duties Program Leadership and Strategy • Develop, implement and continuously refine a strategic vision for the physical health care management programs in line with organizational goals • Lead long-range planning to anticipate future developments (regulatory changes, Medicaid Managed Care evolution, payment model shifts, etc.) that impact physical health care management • Lead quality improvement initiatives with the use of data and analytics to identify gaps in care or process inefficiencies and implement corrective action • Develop strategies for reducing avoidable hospitalizations, readmissions, improving preventive care uptake • Serve as liaison with external stakeholders such as payers, state agencies, provider networks, regulatory bodies, community partners • Ensure that member experience is central to care management efforts Program Development and Oversight • Oversee care coordination and care transitions programs to ensure smooth transitions across care settings (hospital to home, specialist to primary care, plan to plan) • Oversee Care Management programs for high-risk populations (pregnant women, children, people needing LTSS, individuals with chronic conditions) • Collaborate across the Clinical Operations Division to promote integrated care and address social drivers of health • Manage budget, resources and staffing for physical health care management department • Recruit, train, mentor and develop care management teams including clinical managers, case managers and front-line staff Regulatory and Compliance • Accountable to oversee the development of new and maintenance of existing training, desk references, workflows, and other tools to support CM physical health operations related to policies and procedures • Responds to new or changes to regulatory requirements to ensure policies and operational procedures align, are revised, or created to reflect regulations Program Leadership and Strategy • Develop, implement and continuously refine a strategic vision for the physical health care management programs in line with organizational goals • Lead long-range planning to anticipate future developments (regulatory changes, Medicaid Managed Care evolution, payment model shifts, etc.) that impact physical health care management • Lead quality improvement initiatives with the use of data and analytics to identify gaps in care or process inefficiencies and implement corrective action • Develop strategies for reducing avoidable hospitalizations, readmissions, improving preventive care uptake • Serve as liaison with external stakeholders such as payers, state agencies, provider networks, regulatory bodies, community partners • Ensure that member experience is central to care management efforts Minimum Requirements Education & Experience Bachelor’s degree in nursing with RN license and seven (7) years of experience with the population served, including five (5) years of supervisory, consultative, and administrative experience managing clinical and non-clinical resources/business areas. Must have demonstrated experience leading and managing a broad and diverse business operation. Preferred: Health Plan Managed Care experience highly preferred. Knowledge, Skills, & Abilities • Proven record of working with NC Medicaid Managed Care programs • Demonstrated ability to integrate physical and behavioral health, social services, and pharmacy services • Strong knowledge of NC Medicaid policy and regulatory requirements • Excellent data analytics skills; ability to turn data into actionable insights • Leadership, change management and ability to lead across silos • Financial acumen, budget planning and cost-benefit analysis Salary Range $135,630-$172,929/Annually Exact compensation will be determined based on the candidate's education, experience, external market data and consideration of internal equity. An excellent fringe benefit package accompanies the salary, which includes: • Medical, Dental, Vision, Life, Long Term Disability • Generous retirement savings plan • Flexible work schedules including hybrid/remote options • Paid time off including vacation, sick leave, holiday, management leave • Dress flexibility Education Required • Bachelors or better in Nursing Licenses & Certifications Required • Registered Nurse Equal Opportunity Employer This employer is required to notify all applicants of their rights pursuant to federal employment laws. For further information, please review the Know Your Rights notice from the Department of Labor.