Health Services Director

Overview

Required skills and experience: · BSN, other 4-year clinical degree will be considered · 3+ years of hospital clinical experience, plus home care, health plan, or hospice experience · 7+ years of progressive experience in healthcare management, operations, and program development · Expertise in Case Management, Utilization Management, Performance Improvement · Experience using analytics, metrics, and user feedback to drive strategy and execution · Ability to develop clinical programs with clear demonstration of results · Understanding and experience with clinical services products (i.e., disease management, wellness, etc.) or provider network management services or offerings · Experience developing and implementing innovative clinical programs · Strong knowledge of HEDIS measures, quality gap management, STAR ratings · Full understanding of Patient Satisfaction, CAHPS reporting and experience developing improvement strategies · Experience growing business by understanding customer insights and competitive intelligence · Solid computer skills including Microsoft Office programs (Excel, Power Point) and Visio What you need to know: Your Role The Health Services Director (HSD) is responsible for evaluating and supervising overall activities for health maintenance and promotion programs. Provides strategic leadership and is accountable for clinical programs for product lines and members served to ensure contractual compliance and achievement of clinical, quality, and utilization management goals. HSD is responsible for developing the capabilities and refining the strategies required to effectively launch, grow and manage the products within Health Services—clinical programs, vendor relationships, and technology enabled health programs. They balance the needs of our business and ensure that solutions identified are both valuable and viable. In addition, the HSD will work closely with key internal partners including but not limited to Business Development, Medical Management, Operations, Education, Implementation, and Human Resources. This role oversees a team that includes but is not limited to: Nurse Care Managers, Social Workers, Health Coaches, Dietitian, Care Coordinators, and Transition of Care Coordinators. Primary responsibilities for this role: · Build and maintain relationships with joint venture partners, health plans, collaborative partners, vendors, Health Information Exchanges (HIE’s), healthcare systems (i.e., hospitals, SNF, ALF, Home Care, DME vendors), and community-based organizations (i.e., meals on wheels, transportation companies) · Develop and monitor clinical and business dashboards/metrics that drive patient outcomes and performance metrics · Understand HEDIS measures and standards. Assist in the development of a plan to close gaps, as needed · Manage Complaints and Grievances, ensuring required response timeframes are met · Develop/collaborate a process to manage internal and external referrals for healthcare service (i.e., BH referral, Home Health) and specialists (i.e., cardiology, pulmonology) · Oversee the development of community-based resource manual, update periodically to remain relevant · Incorporate principals of Utilization Management into practice to ensure healthcare services are delivered timely, for the right length of time, achieving high quality outcomes · Manage Direct Admit to SNF process with your team by ensuring appropriate criteria and medical documentation is submitted to accepting agency. Work in collaboration with medical team, offices, medical records · Write Health Services policy and protocols and review/revise annually · Develop Health Services job descriptions and collaborate with recruiters on staff hiring · Staff oversite: Complete performance reviews, identify individual staff goals, mentor and support staff for professional growth and learning opportunities · Develop and implement disease state management and evidence-based practices that are interdisciplinary in approach and design · Collaborate to develop innovative solutions and programs to overcome healthcare barriers · Works closely with Staff education and onboarding personnel to ensure education and training continues to meet evolving staff needs. Identify staff needs and determine resources to further enhance knowledge and professional growth · Develop field guidebooks that create consistency in practice and protocols and enhances on the job learning for team members Additional job details: Preferred Qualifications · MPH, MBA or related graduate degree · Experience in interdisciplinary team management · Experience acquiring and analyzing data using appropriate standard quantitative methods across a spectrum of business environments to facilitate process analysis and improvements

Qualifications

• Bachelor's degree or higher
• 3+ years of experience in ANY of the following:
  • Hospital Clinical Experience
  • Home Care
  • Health Plan
  • Hospice Care
  • Microsoft Office
• 7+ years of experience in ANY of the following:
  • Healthcare Management
  • Healthcare Operations
  • HEDIS
  • CAHPS
• Are you comfortable working in a start-up environment?

• Describe your experience with value based care?

Benefits

Company

Our client is a Home Health Care Service company that partners with local Primary Care Doctors to continuously challenge the status quo in care provided for people with Medicare. They focus on the whole care experience. This means improved patient outcomes and it also saves money.