DIRECTOR OF CARE MANAGEMENT RESUME EXAMPLE
Published: Nov 26, 2024 - The Director of Care Management spearheads the development of processes to accurately measure success in achieving critical KPIs, and enhancing team performance through targeted 1:1 coaching, professional development, and efficient patient interaction strategies. Oversees comprehensive insurance appeal processes, lead conversion enhancements, and the implementation of payor policy updates, ensuring all workflows are optimized for TMS and ketamine treatment authorizations. Guarantees the efficiency of the referral process and maintains stringent adherence to pre-certification policies to mitigate financial risks effectively.
Tips for Director of Care Management Skills and Responsibilities on a Resume
1. Director of Care Management, HealthLink Solutions, Springfield, IL
Job Summary:
- Lead care management team- training/onboarding and development, performance, and program optimization.
- Define Key Performance Indicators (KPIs) for the care management team by collaborating with medical and operational leadership.
- Develop processes to measure success towards achieving these KPIs.
- Support care management team in 1:1 coaching, professional development, program solving, role playing, patient interaction, etc. to improve referral conversion rates.
- Ensure insurance appeal efficiency, interventional lead conversions, communication and implementation of payor policy coverage updates, and procedural internal auditing, as well as refining any workflow processes
- Contribute to the training program for new and existing providers in partnership with the clinical training team.
- Create and optimize workflows to initiate and obtain insurance authorizations for TMS and esketamine treatments in compliance with payor coverage policies.
- Ensure efficient referral process, from obtaining the initial referral from the clinician until final disposition, acceptance, or denial.
- Consistently analyze metrics and utilize them for training and performance improvement.
- Ensure timely authorization of all patients requiring pre-certification and maintain accountability for conversion percentage and results.
- Ensure all policies governing commercial pre-certification and authorization are followed to minimize financial risk.
Skills on Resume:
- KPI Setting (Hard Skills)
- Process Creation (Hard Skills)
- Staff Coaching (Soft Skills)
- Workflow Design (Hard Skills)
- Training Development (Hard Skills)
- Authorization Management (Hard Skills)
- Referral Oversight (Hard Skills)
- Metric Analysis (Hard Skills)
2. Director of Care Management, Wellness Pathways, Reno, NV
Job Summary:
- Provide leadership to ensure the provision of member centered care management with efficient and cost effective operations in conjunction with the VP, Care Management- LTC and in collaboration with the Care Management- LTC leadership team.
- Monitor the day-to-day operations of care management-LTC to ensure smooth progress toward managing quality of care, adherence to compliance with standards and improving overall operations.
- Evaluate overall performance of the care management programs by gathering, analyzing and interpreting data and metrics.
- Create process and dashboards that represent improved clinical and business processes through analysis and collaboration with the care management leaders.
- Lead special projects and support clinical projects by ensuring all reports are completed timely and adhere to regulatory standards and HF policies and procedures.
- Collaborate with care management leaders to develop budget planning, preparation and adherence along with budget forecasting.
- Responsible owner for all the Care Management Partnership Service Level Agreements and key performance indicators (KPIs).
- Collaborates with the various departments to ensure all SLAs are adhered to, revised and updated, and reaffirmed by the partnerships routinely.
- Participate and assist in long-term business planning at the managerial and executive level for the Integrated Product Lines
- Co-owner of the Quality Health Incentive Program (QHIP), with the collaboration of the Population Health Department.
- Ensures the yearly QHIP goals and initiatives are directed and implemented to the responsible recipients timely.
- Responsible for the welcome and enrollment and disenrollment activities of member coming on the plan’s Integrated Product lines.
Skills on Resume:
- Leadership (Soft Skills)
- Operations Monitoring (Hard Skills)
- Performance Evaluation (Hard Skills)
- Data Analysis (Hard Skills)
- Project Management (Hard Skills)
- Budget Management (Hard Skills)
- SLA Management (Hard Skills)
- Interdepartmental Collaboration (Soft Skills)
3. Director of Care Management, Integrated Health Services, Tallahassee, FL
Job Summary:
- Provide exemplary leadership in a time of rapid growth and change
- Evaluate, benchmark, and improve productivity standards and metrics
- Build relationships and cultivate networks
- Influence and negotiate contracts
- Implement strategies to achieve business and financial success
- Works in concert with network colleagues to achieve standardization of operations.
- Encourage and model teamwork, communication, and collaboration with other departments to include, but not limited to, a smooth and effective hand-off of patients.
- Produce learning materials and articulate key concepts in a consistent clear manner.
- Work collaboratively with different quality care initiatives such as Clinical Decision Support, Medical Leadership, system performance and other consultants and staff.
- Participate and collaborate in case conferences.
Skills on Resume:
- Leadership (Soft Skills)
- Productivity Improvement (Hard Skills)
- Networking (Soft Skills)
- Contract Negotiation (Hard Skills)
- Strategy Implementation (Hard Skills)
- Standardization (Hard Skills)
- Team Collaboration (Soft Skills)
- Learning Material Development (Hard Skills)
4. Director of Care Management, CareBridge Medical, Charleston, SC
Job Summary:
- Overall strategy and implementation of all hospital-based care management functions including utilization review, discharge planning, complex case processes, and utilization management with regards to LOS, denials, and readmission improvement.
- Serve as a resource and content expert for Carroll Hospital’s leadership team concerning best practices, regulatory and compliance, and process improvement for Care Management.
- Ensure compliance with regulatory agencies and ensures third party payer reimbursement/coverage is approved to meet patients' level of care.
- Work in close collaboration with other leaders across the LBH system to develop and implement policies and procedures supporting the health system’s population health goals for high quality, lowered cost and appropriate utilization for individuals across the continuum of care.
- Accountable for facilitating integrated clinical services for varied patient populations including new services and chronic care.
- Accountable for implementing care management programs within Medical Center.
- Ensures collaboration among health care providers across the Continuum of Care to maximize effective access and efficient utilization of resources.
- Ensure that there are systems in place for effective and timely communication with patients, families, Providers and insurers.
- Facilitate the consolidation of clinical data to ensure timely and accurate measurement of patient outcomes and care processes within Health Systems.
- Understands the financial impact of contracts and prospective payment systems.
Skills on Resume:
- Regulatory Compliance (Hard Skills)
- Policy Development (Hard Skills)
- Care Integration (Soft Skills)
- Program Implementation (Hard Skills)
- Resource Utilization (Soft Skills)
- Communication Systems (Hard Skills)
- Data Consolidation (Hard Skills)
- Financial Analysis (Hard Skills)