Director of Care Management
Posted on Aug 13, 2019 by Morgan Consulting Resources, Inc.
Morgan Consulting Resources, Inc. has been retained by P3 Health Partners (P3HP) to conduct a search for a Director of Care Management, located in Tucson, AZ (there may be some commuting opportunities). This is an exceptional opportunity to do meaningful work affecting the future of healthcare and to be part of a fast- growing, physician-led organization that keeps patients at the center of care.
About the Company:
Founded in 2015, P3 Health Partners is a patient-centered and physician-led population health-management company. Founded and led by physicians, P3HP is a team of doctors, clinicians and support service professionals with a shared passion and purpose for improving the way patient care is delivered. Their business strategy is to support providers, care teams and practices in their journey from traditional volume-based models to value-based systems of care and wellness. Through strategic partnerships, they strive to make healthcare better for millions of patients and their families, thousands of clinicians and caregivers, and dozens of payers.
Currently operating in Nevada and Arizona, P3HP is also assessing opportunities in multiple states. They are building scalable care delivery systems that accept and manage clinical and financial risk for large patient populations. Visit P3HP's website at further information about the company.
About the Position:
Reporting to the National Director of Medical Management, the Director of Care Management is responsible for managing a team of 10 nurses and care navigators (some based in Tucson and others are remote). Ideal candidates will be strong leaders who excel at mentoring and developing teams through continual change as the organization evolves.
We are seeking a driven, self-starter who thrives in an entrepreneurial environment and will complement P3HP's strategic and agile team. The ideal candidate will be comfortable with technology and data.
- Knowledge of Medicare Advantage insurance structure and value based care.
- Collaborates with senior leadership in the development of department strategic goals and objectives to align with overall organizational goals and financial targets. Ensures program integration and implementation of Quality Improvement (QI) activities to ensure services provided meet the needs of the member.
- Works strategically to advance P3 Health Partners in the community and among health plan clients. Monitors metrics and staff performance to constantly meet or exceed all organizational targets.
- Ensures compliance with all Federal & State Regulations and Requirements and Corporate Policies related to care management; utilization management; prospective/concurrent/retrospective care processes.
- Experience with State and external accreditation, managed care audits and reviews required.
- Assist National Senior Director of Medical Management as needed.
- Ability to work independently under limited direction.
- Proficient with computer and software programs (eg; Microsoft Word, Excel) and the Internet required.
- Ability to learn internal and third-party software systems.
- Some travel required.
- Bachelor's degree in Nursing in required. Master's degree is preferred.
- Minimum five years of clinical nursing experience, including a minimum of two years in a managed care/HMO organization required.
- Minimum two years' managerial experience over a managed care, medical management system required.
- Licensure: License/ability to obtain and current registration to practice as a Registered Professional Nurse in the states where P3 has contracts.
- Experience in care management and/or utilization management program set up, policy and procedure development for efficient programs, understanding of nationally recognized standards and guidelines (CMS and NCQA).
- Experience in utilization management (UM) programs including concurrent review processes.
- Experience applying medical management treatment guidelines and nationally recognized criteria, such as InterQual/McKesson, MCG, or other practical management guidelines required.
- Experience with standard operating procedure writing.
- Knowledge of CMS Star Ratings and components.
Projects and Goals:
- Provide subject matter expertise for new care management system development;
- Help grow and solidify physician relationships; and
- Continue to monitor, mentor and develop staff.
P3HP is highly entrepreneurial and has a supportive and collaborative team culture interlaced with fun. Candidates with proven ability to function well within a fast-paced, hands-on and metrics/data driven environment will excel in the organization. The culture values always doing the right thing for the patients and having fun in the process. Innovation is highly encouraged.