Director, Clinical Assessment Services

Brooklyn NY 11201

Job Description

The Director of Clinical Assessment Services is responsible for leading the development and quality of the Uniform Assessment Systems Team. The Clinical Director establishes implements and evaluates goals and objectives for clinical services that meet and promote the standards of quality and contribute to the total organization. The Director will be responsible for implementing timely clinical services, utilization management, disease management programs, and quality initiatives with a specific emphasis on geriatric and disadvantaged populations.
  • Direct clinical programs and services that will support the highest standards of quality and appropriate clinical services to the geriatric and economically disadvantaged members of Senior Whole Health.
  • Supervise all Uniform Assessment Managers and Registered Nurse Assessors, assuring that assessments are completed timely and in accordance with all New York State regulatory requirements and that all assessments of SWH members and prospects meet standards of excellence.
  • Work with Uniform Assessment Managers to assure smooth operation of clinical department, including all personnel and budget issues, meetings, on-call systems, and professional development.
  • Develop and revise clinical program policies and procedures working in collaboration with other department directors and staff.
  • Participate in internal and external committees and management team meetings as required
  • Collaborate with Vice President of Health Services to develop, implement, and monitor performance standards for clinical assessment services
  • Participate in developing goals, strategies and management practices that will ensure growth, development and financial success.
  • Develop strategies to engage primary care physicians in the care model to which we are committed and identify those providers who are collaborative.
  • Recruit, train, develop and maintain a high quality clinical team of nursing professionals.
  • Provide professional guidance to Quality Improvement and Quality Management initiatives in association with the Vice President of Health Services, Medical Director and SWH corporate leadership.
  • Collaborate with the Outreach/Enrollment team to develop relationships with providers to grow membership.
  • Work with Manager of Client Services, primary clinical providers, and Service Coordinators to assess and meet members’ care and service needs.
  • Work with the Medical Director and the Director of Provider Relations to identify strengths and weaknesses of the provider network and develop appropriate strategies.
  • Oversee the administration of members’ benefits according to our policies and procedures in all care settings, including: service authorization and referral policies, hospital admission and discharge protocols, ancillary services management and assessment of benefit exceptions.
  • Prioritize opportunities for disease management strategies based on membership and develop proactive disease management programs and outcomes’ measurement.
  • Work with Information Systems and Operations on building clinical systems to support clinical care and data reporting needs.
  • Work collaboratively with Sales and Provider Relations staff in new member sales efforts

Qualifications

  • Graduate of an accredited school of nursing: Bachelor’s degree in nursing required, Masters Degree preferred.
  • Registered nurse with current licensure to practice professional nursing in appropriate state
  • Demonstrated skills in administrative performance, including expertise in written/oral communication, supervision of staff, documentation requirements, service coordination and case management.
  • Comprehensive knowledge of nursing practice, applicable rules and regulations and industry standards pertaining to Medicare Advantage Plans.
  • Computer proficiency and a working knowledge of Microsoft programs required.
  • Strong aptitude for data analysis and data-driven strategies

General Job Information

Title

Director, Clinical Assessment Services

Grade

29

Job Family

Clinical Services Group

Country

United States of America

FLSA Status

United States of America (Exempt)

Recruiting Start Date

3/20/2019

Date Requisition Created

3/20/2019

Minimum Qualifications

Education

Bachelors: Nursing (Required), Masters: Behavioral Health (Required)

License and Certifications - Required

BCBA - Board Certified Behavior Analyst - Care Mgmt, LCMFT - Licensed Clinical Marriage and Family Therapist - Care Mgmt, LCSW - Licensed Clinical Social Worker - Care Mgmt, LMHP - Licensed Mental Health Professional - Care Mgmt, LPC - Licensed Professional Counselor - Care Mgmt, RN - Registered Nurse, State and/or Compact State Licensure - Care Mgmt

License and Certifications - Preferred

Other Job Requirements

Responsibilities

  • 5+ years in uniform assessment system experience.
  • 5+ years in health care quality improvement.
  • Licensure is required for this position, specifically a current license that meets State, Commonwealth or customer-specific requirements.  Active RN license  is required.

Magellan Health Services is proud to be an Equal Opportunity Employer and a Tobacco-free workplace. EOE/M/F/Vet/Disabled

“I receive a high level of support from our Senior Management Team to execute on our vision. They are always accessible and approachable, something I’ve found to be very unique to Magellan.”