Sr. Director, Health Services

Florida

Remote position available

Job Description

We 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.

Essential Functions

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  • 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

Title

Sr. Director, Health Services

Grade

30

Job Family

Clinical Services Group

Country

United States of America

FLSA Status

United States of America (Exempt)

Recruiting Start Date

10/14/2019

Date Requisition Created

10/11/2019

Work Experience

Case Management, Managed Healthcare

Education

Bachelors: Nursing (Required)

License and Certifications - Required

RN - Registered Nurse, State and/or Compact State Licensure - Care Mgmt

License and Certifications - Preferred

Other Job Requirements

Responsibilities

Required Qualifications

  • 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.  ​

Preferred Qualification

  • CCM

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.”

Haita Makanji VP of Clinical Strategy and Programs at Magellan MRx