Allegiance Benefit Plan Management, Inc. is a national leader in the administration of innovative and customized employee benefit plans for companies, associations and government agencies across the country. Our highly-trained and experienced team of claims professionals, nurses, doctors, attorneys, accountants, managers, and systems & benefits experts all take great pride in providing outstanding service that dramatically improves the experience, outcomes and cost of healthcare for employers and their members. While Allegiance's goal is to provide clients with the highest level of service, we know that ultimately the products and services we administer serve the needs of individuals and their families. In all that we do, we realize that ours is a business focused on benefiting people and helping to improve their healthcare journey.
REPORTS TO: Senior Vice President LOCATION: Missoula FSLA STATUS: Exempt
The Director Care Management is responsible for the overall strategy, operational performance and outcomes of the company's care management activities. This position is responsible for the oversight of the design, development, and refinement of care management and associated functions to create a continuum of integrated care and experience for our members. This position provides leadership and direction to the Care Management leadership team and is responsible for the oversight and maintenance of URAC accreditation. The director collaborates across the enterprise and with clients to ensure that objectives are aligned, business strategies are delivered and financial, compliance and quality objectives are met.
The incumbent is expected to conduct all communication and assignments professionally with peers, supervisors, subordinates, vendors, customers, and the public.
ESSENTIAL JOB FUNCTIONS:
Essential job functions include the following. Other functions may be assigned as business conditions change.
Strategic development and implementation of care management programs
Provide strategic direction, leadership, and operations oversight to programs and staff to optimize efficiency and effectiveness of Care Management operations
Collaborate with clients to perform consultative services to develop appropriate clinical coordination programs centered on supporting a member with healthcare needs.
Continually refines operational processes and leads review of team processes, workflows and activities.
Communicates and collaborates with senior medical director and Chief Medical Officer for medical management, clinical programs and clinical issues that arise
Direct operational readiness and regulatory/accreditation compliance via formal processes such as policy and procedure, program descriptions, auditing, training, and metric monitoring and management.
Lead the evaluation of program performance based on analysis of data and market requirements to identify and act on opportunities to enhance and improve.
Oversees the development and coordination of quarterly productivity reports and client reporting.
Create and foster an environment where Care Management staff can work effectively and efficiently.
Leads and directs a high performing team including interviewing and hiring and onboarding of employees. Conducts performance evaluation and is responsible for managing employees, including skill and career development, policy administration, coaching on performance management and behavior, employee relations and cost control.
Develop educational plans and implementation of annual training for skill and career development of staff
Works collaboratively with the implementation team and workflow process when adding new clients
Oversee the cost savings analysis for the Case Management and Utilization Management staff for the individual group plans.
Oversee URAC compliance and application/certification processes for the Utilization Management Department.
Participate in administrative meetings & client reporting with Care Management customers, Account Representatives or other group contacts upon request as assigned by supervisor.
Performs other duties and responsibilities as assigned.
DIRECTOR OF CARE MANAGEMENT SERVICES
PHYSICAL WORKING CONDITIONS:
Physical requirements are representative of those that must be met to successfully perform the essential functions of this position. Reasonable accommodations may be made to enable individuals with disabilities
to perform the essential functions. Sitting 80% Reaching Minimal Standing 10% Manual Dexterity Ability to type/keyboard Walking 10% Telephone High Degree Kneeling Minimal Computer Screen High Degree Bending Minimal Lifting 20 pounds
Bachelor's Degree required
Current, active license:
Nursing; Physician's Assistant; Nurse Practitioner
Master's Degree or relevant experience in lieu of master's degree preferred
To perform this position successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions
3 years of progressive management experience, or nursing leadership role, coaching and mentoring.
Superior facilitation, written and oral communications skills to convey complex ideas simply, through written reports and presentation materials.
Strong leadership skills with the ability to generate ideas, support and commitment from constituents.
Must be able to work effectively with cross functional groups, fostering teamwork with a commitment to quality.
Strategic thinking and critical decision making at an enterprise level.
The above statements are intended to describe the general nature and level of work being performed. They are not intended to be construed as an exhaustive list of all responsibilities, duties, and skills required of personnel as classified. By signing this statement, the employee understands the scope of their licensure and will practice within the scope of that licensure. If the status of the licensure/certification changes, the employee will notify the department supervisor of the change immediately. The employee understands that failure to maintain current licensure and/or to practice within the scope of that licensure, as well as failure to report any changes in license status, will result in disciplinary action, up to and including termination.