Director, Care Management & Population Health (Remote)

Summary of Position

Provide vision and leadership for Care Management, ensuring integration into EmblemHealth’s broader population health strategy. Accountable for the execution of clinical programs with organizational goals in patient outcomes, quality measures, and financial performance.
Oversee the design, implementation, and ongoing improvement of care management workflows, ensuring compliance with CMS, NCQA and state specific guidelines.Oversight and evaluation of clinical processes to ensure continuous review and improvement of program(s) process workflows and adherence to NCQA and Regulatory requirements. Develop, implement and/or monitor standardized protocols for clinical and non-clinical team activities to operationalize integrated proactive care review and management of CM strategic plan

Principal Accountabilities 

• Assist in leading the strategic development and deployment of care management & population health programs to support EmblemHealth’s membership. 
• Collaborate with other functional areas within organization to ensure that care managers are implementing EmblemHealth Health Plans policies, procedures and all regulatory mandates, consistent with EmblemHealth plan’s mission, vision, purpose and value statement. 
• Implement and maximize care management & population health programs. 
• Manage the daily operations of the care management programs, including patient enrollment, monitoring protocols, escalation pathways, and reporting. 
• Facilitate/promote problem identification, analysis and resolution within care management operations to improve member outcomes and/or experience. 
• Hire, mentor, coach, and build a high performing multidisciplinary team culture that emphasizes accountability, patient-centered care, and professional development.
• Manage daily operations of the Care Management team (Managers and Care management team): define metrics; measure performance and productivity against standards; deploy strategies to improve performance.  

• Monitor care management performance including program adherence, compliance and optimization; 

  monitor employees’ performance regularly and coach employees as needed including team caseloads, workloads and compliance with department and regulatory standards.

• Monitor timeliness and appropriateness of documentation in clinical systems to ensure that accreditation and regulatory standards are met.  
• Analyze data and identify trends monthly to ensure company expectations meet or exceed industry benchmarks and regulatory requirements. Address audit related findings and implement performance improvement strategies.