Associate Director of Care Coordination

Overview

Under direction from the Director of Care Coordination, manages and provides direction to the Care Coordination (CC) Department Managers and Supervisors for all services. Responsible for establishing and maintaining reports that will support the efficacy of department activity and producing a summary at least annually, or upon request, of CC program activities with documentation of department services, member outcomes, return on investment, and quality improvement activities.

A key component of this position is the enhancement and refinement of existing programs, and enthusiastic innovation in the development, management, integration, and refinement of new and existing programs.

• Provides day-to-day direction to CC Managers and Supervisors to meet department goals and objectives.
• Responsible for ensuring performance evaluations are completed appropriately in a timely manner.
• Reviews Performance Evaluations prior to submission to the Director of Care Coordination.
• Participates in the grievance process.
• Coordinates activities with Member Services, Claims, and Provider Relations departments to identify, track, and monitor quality of care issues and trends.
• Responsible for establishing and maintaining reports that will support the efficacy of each CC activity/program and to produce a summary at least annually or upon request that includes a summary of CC program activities, member outcomes, return on investment, and quality improvement activities.
• Provides oversight and monitoring of the medical claims review, appeals, and grievances within CC to ensure timely accurate response.
• Provides direction and oversight to ensure efficient and appropriate collaboration between the CC staff and the delegated mental health provider and other internal and external organizations.
• Ensures that all policies and procedures are updated at least annually or as needed and presented to appropriate committees for review.
• Works with all other departments to resolve claims, UM, QI, and member issues as necessary.
• Reports any issues with regulatory compliance to Director of Care Coordination and assists in design and implementation of a corrective action plan when necessary.
• Prepares reports on departmental activities according to established schedules and format. Identifies patterns and trends and works with Managers to develop corrective action plans.
• Works with Managers, Supervisors, and Trainer to develop standardized training content and material for new staff and for the ongoing education of existing staff.
• Provides oversight of training program to ensure adequate training accomplishes objectives and results in staff competency.
• Conducts retrospective review for quality, either in the aggregate or on an individual basis, as needed. Provides summaries of findings to the Director of Care Coordination.
• Assists Partnership staff and