Associate Director Clinical Operations- Care Management

Sagility combines industry-leading technology and transformation-driven BPM services with decades of healthcare domain expertise to help clients draw closer to their members. The company optimizes the entire member/patient experience through service offerings for clinical, case management, member engagement, provider solutions, payment integrity, claims cost containment, and analytics. Sagility has more than 25,000 employees across 5 countries. Job title: Associate Director Clinical Operations- Care Management Job Description: The Associate Clinical Operation Director is a clinical leadership role dedicated to the Utilization Management and Case Management programs. The Clinical Director is responsible for the clinical and operational program performance in the US to ensure the program is achieving desired goals. Effectively leads the Clinical Operations team to meet or exceed clinical program goals and client contract agreement(s). Works collaboratively with other Geo leaders to help drive clinical acumen and enhance program delivery. Embraces the clinical model approach of Whole Person Care. Whole Person Care supports individuals as they build confidence to improve their coping skills, physical and emotional health, and take part in a healthy lifestyle. Education:

• Bachelors Degree in Nursing (RN), master’s level preferred
• Certification Case Management (CCM) preferred

Experience:

• A minimum of 7 years’ experience as nurse in a clinical, managed care environment
• Experience working with URAC and NCQA accreditation standards and survey process.
• Knowledgeable of State licensure and UM compliance standards
• A minimum of 5 years care/case management and utilization management experience with emphasis on utilization management.
• Utilization Management experience with Pre-authorization, Concurrent Review, physician review and appeals processes.
• A minimum of 5 years management experience, managing remote team members
• A minimum of 5 years’ experience with government plans (Medicare, Medicaid, Marketplace) preferred
• BPO experience a plus

Mandatory Skills:

• Understanding of Motivational Interviewing and change theory concept
• Knowledgeable regarding state and federal regulations relating to Medicare and Medicaid
• Ability to manage multiple projects to successful and timely completion
• Demonstrated sound problem-solving analytical and decision-making skills
• Knowledge of quality improvement processes
• Excellent communication and presentation skills
• Possesses leadership qualities of integrity, the ability to motivate others and the ability to promote harmony in the workplace
• Works effectively leading a team and participating on a team
• Strong member advocate: willing to go above and beyond normal responsibilities to provide the best service possible
• Ability to assist member in navigating the healthcare system and community-based resources
• Culturally sensitive and competent regarding membership served
• Ability to work remotely
• Ability to determine when to escalate issues appropriately and in a timely manner
• Proficient computer skills

Roles & Responsibilities:

• Responsible for clinical and operational program performance
• Client facing and primary liaison between client and Sagility
• Responsible for client management and programmatic delivery
• Works with an interdisciplinary care team and internal stakeholders for optimal service delivery and programmatic success
• Communicates policy changes, program developments, and updates to stakeholders in a consistent and timely manner.
• Articulates an understanding of all policies and procedures and ensures that they are adhered to and tracked if necessary.
• Manages dedicated teams to include UM, CM, Accreditation, Clinical Acumen, Training and Quality
• Regular and reliable attendance and timeliness
• Other duties as assigned

The above statements are intended to indicate the general nature and level of work being performed by employees within this classification. They are not intended to be an exhaustive list of all responsibilities, duties and skills required of employees assigned to this job. Employees in this job may perform other duties as assigned Location: Work@Home USAUnited States of America Apply tot his job Apply To this Job