The company operates within the Health Care sector.The Director of Care Management is responsible for the management and oversight of care management/care coordination program development and oversight to support Health Plan contractual (value based, delegation, full risk) requirements and/or Federal & State programs in Pennsylvania and New Jersey. Oversees the team responsible for assisting patients in navigating the health care system and ensuring access to evidence based care. Responsible for the clinical, quality, financial and patient outcomes for the IPA and Hospital, including but not limited to admits per 1,000 members and ER visits per 1,000 and readmission rates. Works collaboratively with other members of the health system to create an open, clinicially integrated health system.Registered Nurse (RN) with minimum of 10 years' experience in managed care, health plan or IPA arenas to include Utilization Management, Quality Improvement, inpatient programs, case management programs, health plan incentive programs to include P4P/HCC/STAR/HEDIS. Experienced with health plan guidelines/criteria/ICE/CMS/NCQA/DMHC. Strong clinical background in acute and chronic care management.
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