Director of Clinical Support Services
The Director of Clinical Support Services is responsible for the strategic implementation, program development, and oversight of clinical support services for the CCC Plus program in collaboration with the 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, and ensures compliance with NCQA and contract guidelines. 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.
Here are some of the key responsibilities for this role.
Hands-on clinical operations leadership (including team leadership and development; member and community engagement; and field-based practice operations, among other functions), for the clinical reviewer, operations coordinator, member care specialist, and service authorization coordinator.
Develops front line managers and creates a succession “bench.”
Oversees quality assurance activities of the care coordination team to ensure compliance with the DMAS contract and NCQA standards.
Supports the attainment of quality and production goals by analyzing current work trends and initiating adjustments as needed.
Identifies and makes recommendations for process improvement opportunities based on stakeholder feedback, metrics reports, and contract elements.
Supports company-wide initiatives within the VCU Health Systems enterprise and with external entities.
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 care coordination program.
Researches and determines the information necessary to satisfy specific business and regulatory medical management requirements.
Ensures business processes are in place to monitor and manage the CCC Plus 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 trends; improves resource consumption; identifies and promotes potential cost saving opportunities; and enhances quality of care consistent with health plan’s strategic goals and objectives.
Drives program deployment: understands strategies and issues, drives plans, and ensures smooth transitions.
Participates in audit activities as required in the state contract and for NCQA accreditation.
Consistently demonstrates servant leadership behaviors and attitudes.
MINIMUM EDUCATION REQUIREMENTS
Bachelor’s degree in any field
Masters’ degree preferred
License – Current Registered Nurse licensed to practice nursing in Virginia or multi-state licensure
SPECIAL KNOWLEDGE AND/OR SKILLS
Highly motivated individual with demonstrated leadership to manage cross-functional teams
Experience in managing telecommute staff
Excellent verbal and written communication skills
Demonstrated knowledge of Medicare, Medicaid, NCQA, and HEDIS
Strong knowledge of utilization management, preferably service authorizations related to waiver services
Strong analytical problem-solving, time management, and organizational skills
High proficiency in developing, interpreting, and monitoring dashboards, metrics decks, score cards
High proficiency in Microsoft Office products
Knowledgeable in process improvement methodology
Experience with program start-up and/or enhancements
Minimum of 2 years of operations experience preferably in a clinical setting; managed care preferred
Minimum of 5 years management experience
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
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