DIRECTOR OF CARE MANAGEMENT SKILLS, EXPERIENCE, AND JOB REQUIREMENTS
Published: Nov 26, 2024 - The Director of Care Management excels in leading innovative case management programs and teams, specializing in utilization management and effective discharge planning. With extensive experience in financial utilization data analysis and interpretation, presents actionable insights to optimize healthcare delivery within managed care settings. Combines a deep understanding of ACMA, CMSA, and NASW standards with strategic thinking and critical decision-making skills, enhancing care management practices through advanced proficiency in Microsoft Office and Visio.
Essential Hard and Soft Skills for a Standout Director of Care Management Resume
- Case Management
- Utilization Management
- Discharge Planning
- Data Analysis
- Financial Reporting
- Health Informatics
- Regulatory Compliance
- Strategic Planning
- Policy Development
- Electronic Health Records
- Leadership
- Communication
- Problem Solving
- Empathy
- Team Collaboration
- Decision Making
- Adaptability
- Conflict Resolution
- Time Management
- Stress Management
Summary of Director of Care Management Knowledge and Qualifications on Resume
1. BA in Nursing with 10 Years of Experience
- Experience in leading innovative case management programs and teams
- Expertise in utilization management and discharge planning
- Experience in analyzing, interpreting, and presenting financial utilization data
- Leadership experience in case of management in a third party administration or managed health care setting
- Knowledge of ACMA, CMSA and NASW Standards of Practice
- Knowledge of available health care and community resources
- A broad knowledge base of health care delivery and case management within a managed care environment
- Strategic thinking and critical decision-making at an enterprise level.
- Ability to work independently and within a team environment
- Advanced knowledge of Microsoft Word, Excel, PowerPoint and Visio
2. BA in Health Care Administration with 3 Years of Experience
- Progressive management experience
- Experience in leading operations for multiple practices within a multi-site healthcare services business
- Operations experience in Medicare Advantage risk management
- Experience with successful integration of acquired practices and adoption of standardized operations processes for those practices
- Proven success engaging with and positively influencing physicians in a multi-site healthcare business
- Track record of successful fiscal and operating leadership; demonstrated financial expertise
- Ability to handle fast-paced environment and prioritize tasks in a dynamic way
- Excellent communication and problem-solving skills
- Proficiency with Microsoft Office (Excel, Word, etc.) and other desktop publishing software
- Ability to thrive in ambiguity and adapt approach
3. BA in Public Health with 8 Years of Experience
- Demonstrated maturity, flexibility and capacity to navigate a complex structure with strong critical thinking, problem-solving/conflict resolution skills.
- Superior facilitation, written and oral communications skills to convey complex ideas simply, through written reports and presentation materials.
- Strong leadership skills with the ability to generate ideas, support and commitment from constituents.
- Demonstrated team building, mentoring and coaching skills with experience leading professional staff.
- Strong business acumen and understanding of cross-industry business practices, market and competitive drivers.
- Demonstrated ability to drive and execute results in a complex cross functional environment.
- Demonstrated knowledge of healthcare payer industry and business processes.
- Ability to see across the enterprise and identify potential risks and issues that impact other ongoing work efforts.
- Strong teamwork and interpersonal skills at all levels.
- Demonstrated ability to understand business strategy, including deep expertise with the accountability of scope and relate that strategy to program execution business knowledge across multiple functional areas.
4. BA in Social Work with 6 Years of Experience
- Experience providing supervision to RN care managers, social workers, community health workers, and/or care coordinators
- Experience leading the day-to-day operations of interdisciplinary teams
- Direct experience supporting at-risk populations with complex needs in multiple settings ambulatory and inpatient - and/or products - Medicaid, Medicare, Behavioral Health
- Experience ensuring quality and compliance in a tightly regulated healthcare environment
- Experience using technology to manage patient care
- Experience in a similar leadership role with accountability for multiple settings/geographies
- Experience with in-home care and homebound populations
- Familiarity with CPT code billing for patient care
- Familiarity or experience with RAF scores and risk-based arrangements
- Ability to work in a fast-paced environment
5. BA in Business Administration with 8 Years of Experience
- Strong data analysis and trending skills
- Strong project management skills
- Strong team and staff development skills
- Strong collaboration and conflict resolution skill sets
- Proven leadership with the ability to build relationships/collaborate and influence at all levels
- Strong process and analytical skills with the ability to articulate and define outcome measures that capture key performance metrics
- Ability to develop, prioritize, and accomplish goals/time management
- Strong decision-making and problem-solving skills
- Exceptional communication skills (both written and verbal) with the ability to present information in a variety of different formats to all levels
- Strong ability to teach best practice, engagement strategies for successful member participation (including motivational interviewing, and best practice engagement techniques)
- Executive and Strategic management skills
6. BA in Health Services Management with 9 Years of Experience
- Strong clinical background with a focus on geriatrics and extensive experience in managed care systems and operations.
- Experience in care management and working with complex populations
- Experience in managed care and/or population health/utilization management with a minimum of three years at the management level or above
- Knowledge of basic principles and practices of clinical geriatric care
- Comprehensive knowledge/experience in managing Medicaid services, particularly LTSS services
- Proficient with computer software programs, including word processing, spreadsheets graphics, and databases
- Must have a proven ability to achieve goals and deliver “bottom line” results.
- Excellent working knowledge of managed care is essential, with key expertise in the areas of case management, utilization management, provider relations, CMS, and quality improvement.
- A proven ability to successfully lead staff
- Results orientation - drives to meet business-driven goals
- Extensive experience with SDoH
- Experience with HEDIS scoring, CAHPS, and HOS to achieve 5 5-star Medicare rating
7. BA in Gerontology with 5 Years of Experience
- Previous experience in a clinical setting, supervising and managing experience in a primary care coordination/management
- Knowledge of evidence-based clinical practice guidelines
- Knowledge of how to use Electronic Medical Records and computerized statistical methods in clinical quality improvement
- Skill in the effective application of evidence-based clinical practice guidelines
- Ability to communicate Clinical Quality and Disease Management concepts methods and tools in a clear and persuasive manner in verbal and written forms to a variety of audience
- Strong assessment critical thinking judgment creativity and decision-making skills
- Strong instruction coaching and mentoring skills
- Skilled in communication, both verbal and written
- Ability to work effectively in a complex environment by establishing effective working relationships with all departments and levels of staff
- Ability to lead and manage teams of clinical and non-clinical professionals
- Ability to adapt to an environment