Director, Clinical Assessment Services

Brooklyn NY 11201 Brooklyn 3 15 MetroTech Center SWH

Job Description

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.
  • Directs 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.
  • Supervises 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.
  • Works with Uniform Assessment Managers to assure smooth operation of clinical department, including all personnel and budget issues, meetings, on-call systems, and professional development.
  • Develops and revises clinical program policies and procedures working in collaboration with other department directors and staff.
  • Participates in internal and external committees and management team meetings as required
  • Collaborates with Vice President of Health Services to develop, implement, and monitor performance standards for clinical assessment services
  • Participates in developing goals, strategies and management practices that will ensure growth, development and financial success.
  • Develops strategies to engage primary care physicians in the care model to which we are committed and identify those providers who are collaborative.
  • Recruits, trains, develops and maintains a high quality clinical team of nursing professionals.
  • Provides professional guidance to Quality Improvement and Quality Management initiatives in association with the Vice President of Health Services, Medical Director and SWH corporate leadership.
  • Collaborates with the Outreach/Enrollment team to develop relationships with providers to grow membership.
  • Works with Manager of Client Services, primary clinical providers, and Service Coordinators to assess and meet members’ care and service needs.
  • Works with the Medical Director and the Director of Provider Relations to identify strengths and weaknesses of the provider network and develop appropriate strategies.
  • Oversees 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.
  • Prioritizes opportunities for disease management strategies based on membership and develop proactive disease management programs and outcomes’ measurement.
  • Works with Information Systems and Operations on building clinical systems to support clinical care and data reporting needs.
  • Works collaboratively with Sales and Provider Relations staff in new member sales efforts

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

1/20/2020

Date Requisition Created

1/20/2020

Work Experience

Clinical, Management/Leadership

Education

Bachelors: Nursing (Required), Masters: Nursing

License and Certifications - Required

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. 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