Associate Director, Care Management presso Viva Health

Associate Director of Care Management

Location: Birmingham, AL

Why VIVA HEALTH?

VIVA HEALTH, part of the renowned University of Alabama at Birmingham (UAB) Health System, is a health maintenance organization providing quality, accessible health care. Our employees are a part of the communities they serve and proudly partner with members on their healthcare journeys.

VIVA HEALTH has been recognized by Centers for Medicare & Medicaid Services (CMS) as a high-performing health plan and has been repeatedly ranked as one of the nation's Best Places to Work by Modern Healthcare.

Benefits

• Comprehensive Health, Vision, and Dental Coverage
• 401(k) Savings Plan with company match and immediate vesting
• Paid Time Off (PTO)
• 9 Paid Holidays annually plus a Floating Holiday to use as you choose
• Tuition Assistance
• Flexible Spending Accounts
• Healthcare Reimbursement Account
• Paid Parental Leave
• Community Service Time Off
• Life Insurance and Disability Coverage
• Employee Wellness Program
• Training and Development Programs to develop new skills and reach career goals
• Employee Assistance Program

See more about the benefits of working at Viva Health - https://www.vivahealth.com/careers/benefits

Job Description

The Associate Director, Care Management will be responsible for the oversight of the day-to-day operations of the Care Management department to include applicable contracted programs. This position is responsible for the coordination, development, administration, and implementation of care coordination and utilization management for the Care Management program and other designated populations.

Along with other leaders, this position will develop and implement strategies to improve member outcomes, quality of care, increase member satisfaction, and meet productivity standards. This position will travel to locations within the relevant service area through a reliable means of transportation insured in accordance with Company policy.

Key Responsibilities

• Make all day-to-day program decisions including overseeing all personnel within the department to ensure staff is providing quality customer service and meeting productivity and quality benchmarks.
• Ensure department is appropriately staffed with qualified and trained employees. Coach and motivate employees by modeling behavior consistent with VIVA HEALTH’S Core Values. Assess and manage performance of management staff; create a positive environment that encourages productivity, innovation, and compliance.
• Work in collaboration with other Health Services leaders and other departments, attaining and improving HEDIS and STARs metrics for VCare and Special Needs Plans (SNP). Meet with external stakeholders as required determining priority areas to be addressed.  Implement plans as indicated.
• Work in collaboration with other Health Services leaders to evaluate opportunities to impact and improve internal processes and best practice for the team.
• Execute strategies, monitor their success on an on-going basis, report on outcomes, and adjust strategies as needed.
• Support the design and oversight of initiatives aimed at improving member health outcomes including transitions of care, complex case management, and social determinant of health interventions.
• Oversee the review and validation of program reports and data files to ensure accuracy, completeness, and alignment with Centers for Medicare and Medicaid Services (CMS) and internal benchmarks. Collaborate with analytics and quality teams to identify discrepancies and ensure timely resolution.
• Review and analyze data reports to identify trends in admissions, readmissions, and utilization patterns. Assess the impact of social determinants of health and other risk factors to develop targeted strategies that close care gaps and reduce avoidable utilization.

REQUIRED QUALIFICATIONS:

• Graduate of a professional program of nursing or a Master’s level degree in a health-related field
• 5 years of management experience in Acute, Post-acute, or managed care setting
• Current RN License or LBSW license in good standing in the State of Alabama
• Valid driver’s license in good standing
• May require significant face-to-face member contact with duties regularly performed away from the principal place of business
• Willing to submit to vaccine testing and screening
• Possess excellent assessment and organizational skills
• Exhibit critical thinking and decision-making abilities, as well as conflict resolution skills
• Excellent verbal, presentation, and written communication skills
• Comfortable speaking to large groups
• Ability to travel overnight as needed
• Ability to perform tasks with little or no supervision
• Basic computer skills including Microsoft Word and Excel

PREFERRED QUALIFICATIONS:

• BSN or a Master’s in Social Work
• Experience in population health and/or chronic care disease management
• Experience working for a Medicare Advantage Plan or Medicaid Plan
• Current LMSW license in good standing in the State of Alabama
• Chronic Care Management (CCM)
• Knowledge of community resources and Medicaid regulations