Job DescriptionWe are seeking a Sr. Director, Health Services to support Magellan Complete Care of Florida (MCC FL). This position can be remote for candidates who reside in Florida as long as candidates are willing to travel to the Orlando office as needed.
This position maintains operational accountability for health services functions to achieve the business and clinical outcomes for the health plan, meeting contract requirements, National Committee of Quality Assurance (NCQA) accreditation standards and supporting initiatives with providers and members to manage cost of care. Directs all health services activities ensuring delivery is consistent with model of care, approved program descriptions and meets state, National Committee of Quality Assurance (NCQA) accreditation standards, Centers for Medicare and Medicaid Services (CMS), and other applicable standards and requirements.
- Plans, directs, provides leadership and oversight of the health services operational processes and staff.
- Serves as Subject Matter Expert for care coordination and case management for state, NCQA, CMS and other accreditation and oversight activities, ensuring clinical programs meet standard and contractual requirements.
- Leads and organizes the ongoing evaluation of the care coordination programs against quality and clinical benchmarks and targets. Identifies opportunities for improvement; organizes and manages cost of care and medical action plan activities. Collaborates with local and national leaders including Quality Improvement, Analytics, Finance, Network, and other areas to assure a comprehensive approach to managing quality of care, service, and cost of care.
- Assures staff selection, training, and evaluation to promote the development of a high-quality team and effective transitions of care with the clinical care teams.
- Works closely with and provides input to the national health plan clinical team on program design, policies, procedures, workflows, and correspondence.
- Directs, coordinates and oversees the evaluation of efficiency and productivity of care coordination functions, including complex case management, chronic disease programs, health promotion for physical and behavioral health as well as the work of peer support specialists and health guides.
General Job Information
TitleSr. Director, Health Services
Job FamilyClinical Services Group
CountryUnited States of America
FLSA StatusUnited States of America (Exempt)
Recruiting Start Date10/14/2019
Date Requisition Created10/11/2019
Work ExperienceCase Management, Managed Healthcare
EducationBachelors: Nursing (Required)
License and Certifications - RequiredRN - Registered Nurse, State and/or Compact State Licensure - Care Mgmt
License and Certifications - Preferred
Other Job Requirements
- RN Licensure
- Experience overseeing contractual performance standards.
- Minimum 7 years managed healthcare experience in a Medicaid plan providing leadership in a clinical role.
- Strong verbal and written communication skills.
- Minimum 5 years direct supervisory experience including responsibility for analyzing cost of care results, cost of care opportunities, quality measurement and performance metric development and achievement.
Magellan Health Services is proud to be an Equal Opportunity Employer and a Tobacco-free workplace. EOE/M/F/Vet/Disabled. Every employee must understand, comply and attest to the security responsibilities and security controls unique to their position.
“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.”