• Director, Health Services

    Job Locations US-VA-Glen Allen
    Job ID
    2018-5094
  • About Us

    Don’t just find a job, find your WHY at a purpose-driven organization; discover a career at Virginia Premier.
    By blending quality benefits, affiliating with the world-renowned VCU Health System and offering career-advancing development programs, we allow our employees to focus on the meaningful work of improving and saving the lives of more than 200,000 people throughout the state of Virginia.
     
    At Virginia Premier, we are building an industry leading health care organization through dedicated teams that have heart, provide top-notch quality member services and embrace our mission of inspiring healthy living within the communities we serve. Our vision is to connect people to innovation, quality and affordable health care for all phases of life.
     
    If this sounds like you, read on!

    Overview

    The Director of Health Services is responsible for the strategic implementation, program development, and oversight of clinical operations for the CCC Plus and Dual Special Needs Programs in collaboration with the Associate Vice President of Health Services.  The Director coordinates duties with appropriate personnel to meet operational program needs, ensures compliance with state and federal health plan requirements, makes recommendations for program enhancements to improve care delivery, ensures compliance with NCQA guidelines, and provides leadership presence in the satellite offices throughout the state. .  The Director will assist senior leadership with long-term planning initiatives to maintain operations assuring activities are appropriately integrated into the overall strategic plan for the organization

    Responsibilities

    • Responsible for planning and implementing assigned regional market success initiatives with each region’s team
    • Oversees the Health Services’ Department and staff role s and responsibilities
    • Works with  medical management  staff to provide guidance and/or intervention in problematic/unusual cases in all office locations
    • Supports company-wide initiatives within the VCU enterprise and with external entities
    • Serves in an advisory capacity for problem solving, reviewing reports being sent to internal and external customers, reviewing problematic cases, and monitor case management activities
    • Participates in public speaking presentations and community education initiatives on behalf of Virginia Premier as needed
    • Assists AVP of Health Services in ongoing Quality Improvement initiatives by assisting with various quality review tasks such as collecting and analyzing data as outlined in the program
    • Ensures program processes and policies are aligned with NCQA standards
    • Assists in the ongoing development of programs and medical management projects to enhance/expand the case management/care coordination program
    • Ensures business processes are in place to monitor and manage the CCC Plus and DSNP operational processes as defined by the state contract and/or national standardized model components
    • Monitors and tracks program  metrics, dashboards, and other reporting tools to drive action and improvements
    • Analyzes data to identify under/over utilization; improve resource consumption; promote potential reduction in cost; and enhance quality of care consistent with health plan’s strategic goals and objectives
    • Drives program deployment: understands strategies and issues, drives plans, ensures smooth transitions
    • Define, document and prioritize change impacts for clinical programs across functions
    • Provides training, mentoring and coaching where appropriate
    • Participates in audit activities as required in the state contract and for NCQA accreditation

    Qualifications

    MINIMUM EDUCATION REQUIREMENTS

    • Minimum education degree of Bachelors of Science in a health care field
    • License – Current Registered Nurse licensed to practice nursing in Virginia;
    • Certified Case Manager (CCM) preferred

    SPECIAL KNOWLEDGE AND/OR SKILLS

    • Highly motivated individual with the ability to work independently as well as part of a team
    • Excellent verbal and written communication skills
    • Knowledge of NCQA and HEDIS
    • Demonstrated knowledge of Case Management principles
    • Strong analytical problem-solving, time management, and organizational skills
    • Proficient Microsoft Office product computer skills
    • Knowledge of community resources and vendor options and experience in making appropriate referrals
    • Ability to negotiate with providers, vendors and care providers
    • Knowledgeable in process improvement methodology such as LEAN and Six Sigma
    • Knowledge in program start-up and/or enhancements

    WORK BACKGROUND/EXPERIENCE

    • Minimum of 5 years of case management experience preferably in a managed care setting
    • Minimum of 5 years of management experience
    • Knowledge of utilization management, preferably service authorizations related to waiver services
    • Minimum of 2 years of experience in Medicaid and Medicare managed care

    PHYSICAL REQUIREMENTS

    • Physical health sufficient to meet the ergonomic standards and demands of the position.

     

    All qualified applicants will receive consideration for employment without regard to age, race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or protected veteran status. EOE

     

    Our mission is to inspire healthy living within the communities we serve!

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