Position Summary:

The Medicare Health Services Director will strategize, develop and direct operations of the community health services department to ensure provision of high quality, cost-effective medical services. Will be responsible for the development and management of budget related medical care, direct actions to control targeted costs for inpatient and outpatient services in conjunction with the site medical expense team. Will ensure compliance with State and Federal regulations, compliance with company policies and procedures and will form internal and external strategic relationships which will support program expansion and continuing success.

Primary Responsibilities:

* 40% in Medical Management

o Develop and routinely update comprehensive medical management work plans/programs for the institutional program.

o Review periodic reports (financial/utilization/services) analyze trends and implement timely corrective action plans

o Review and implement medical management policies and procedures to ensure compliance with the State and Federal regulations and with Evercare protocols

o Strategize and implement a clinical model which is focused on quality, reduces medical cost appropriately and which incorporates the skills of provider partners whenever possible

o Direct the implementation of disease-specific, cost-containment strategies identified by Evercare corporate and reflected in practice protocols/guidelines.

25% in Program Quality

• Direct the development of well designed processes which when fully implemented, will be evident in daily work flows which are efficient and support the achievement of the Community Health Services goals.
• Directs the integration of the local quality assurance committee activities into clinical practice as appropriate.
• Conduct regular meetings with staff to address issues, concerns, and to communicate corporate and site-specific philosophy.
• Oversee the integrity of the patient-data base system to ensure consistency in the data entry and the integrity.
• Coordinate plans with the local and national quality committee to comply with regulations and accreditation agencies.

20% in Intra-agency Partnerships

• Implements a program that will address the needs of the marketplace.
• Strategize and evaluate methodologies for program adaptation and integration within partnering organizations.
• Conduct regular agenda-driven meetings with selected partners to promote program visibility and support a dynamic relationship with selected organizations
• Direct the development of results-oriented relationships with contracted facilities or the associated consortium or corporation.
• Strategize with the senior staff about program expansion/development/new models/new alliances
• Implement new programs or new care models.

15% in Staff Retention and Development

• Manage salary, bonus incentives, and enforce work rules in a manner that rewards excellent performance and minimizes staff attrition while meeting budget requirements.
• Direct the orientation, training, and on-going education and skill development of the institutional health services staff.
• Conduct routine meetings with staff to address issues, concerns, and communicate site and corporate philosophies and directives.
• Participate in and lead special project groups which provide skill building opportunities for the participants and allows others to display leadership capabilities.

Qualifications:

• RN with current licensure, BSN preferred.
• Master's Degree prepared in nursing, health sciences, social services or business preferred.
• 3-5 years leadership and management experience in an organization that services the elder, chronically ill or frail population.
• Experience with Medicare, Medicaid and managed care in a variety of health care settings.
• Strong negotiation skills, budget management experience and regulatory knowledge.
• Leadership and management experience in effective team building and continuous quality improvement programs.
• Working knowledge and experience in cross-functional business segments and their integrated influences and relationships.
• Effective and experienced in motivating and mentoring others who are not in a direct reporting relationship.

Diversity creates a healthier atmosphere: equal opportunity employer M/F/D/V