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Director of Care Management

Company: P3 Health Partners
Location: Tucson
Posted on: June 24, 2022

Job Description:

P3 Health Partners is committed to ensuring the health and safety of our team members, patients and communities we serve. As a part of this commitment, all candidates must receive their COVID-19 vaccine prior to joining the team. If you have any questions about our interview and hiring procedures, please contact PeopleServices@p3hp.org.

People. Passion. Purpose.

At P3 Health Partners, our promise is to guide our communities to better health, unburden clinicians, align incentives and engage patients.

We are a physician-led organization relentless in our mission to overcome all obstacles by positively disrupting the business of health care, transforming it from sickness care into wellness guidance.

We are looking for a Director of Care Management. If you are passionate about your work; eager to have fun; and motivated to be part of a fast-growing organization in Tucson, Arizona, then you should consider joining our team.

Director of Care Management - Tucson, AZ

Overall Purpose:

The Director of Care Management is a Registered Nurse with a current, unrestricted license that will be responsible for CM staff, collaboration with utilization management on concurrent review functions, and program oversight. Additionally, this position is responsible for health plan, Special Needs Program, and CMS reporting over multiple health plans. This position is responsible for development and oversight of care management functions, staffing, and daily operations for multiple delegated managed care health plan contracts. A successful candidate will have the following experience and qualifications:

Education and Experience:

* Bachelor's degree in Nursing in required. Master's degree in preferred.
* Minimum five years of clinical nursing experience, including a minimum of two years in a managed care/HMO organization, required.
* Minimum two years managerial experience over a managed care, medical management system required.
* Licensure: License / ability to obtain and current registration to practice as a Registered Professional Nurse in the states where P3 has contracts.
* Experience in care management and/or utilization management program set up, policy and procedure development for efficient programs, understanding of nationally recognized standards and guidelines (CMS and NCQA).
* Experience with Special Needs Plan Model of Care standards, execution, reporting and auditing.
* Experience in utilization management (UM) programs, specifically concurrent review processes.
* Experience applying medical management treatment guidelines and nationally recognized criteria, such as InterQual / McKesson, MCG, or other practical management guidelines required.
* Experience with standard operating procedure writing.
* Experience with internal and external audit processes.
* Knowledge of CMS Star Ratings and components.

Essential Functions:

* Knowledge of Medicare Advantage insurance structure and value-based care.
* Collaborates with senior leadership in the development of department strategic goals and objectives to align with overall organizational goals and financial targets. Ensures program integration and implementation of Quality Improvement (QI) activities to ensure services provided meet the needs of the member.
* Works strategically to advance P3 Health Partners in the community and among health plan clients. Monitors metrics and staff performance to constantly meet or exceed all organizational targets.
* Ensures compliance with all Federal & State Regulations and Requirements and Corporate Policies related to care management; Special Needs Plans; prospective / concurrent / retrospective care processes.
* Experience with State and external accreditation, managed care audits and reviews required.
* Assist SVP of Population Health, as needed.
* Ability to work independently under limited direction.
* Proficient with computer and software programs (e.g.; Microsoft Word, Excel) and the Internet required.
* Ability to learn internal and third-party software systems.

Keywords: P3 Health Partners, Tucson , Director of Care Management, Executive , Tucson, Arizona

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