Director, Complex Health Management

Position Title:   Director, Complex Health Management

Reports To:VP, Clinical Operations

About Us:

The Columbus Organization is a group of caring professionals whose mission is to assist individuals at risk with complex care needs. These individuals need to remain in the least restrictive environment of their choice while improving their quality of life through coordinated services and support. With a person-centered planning & thinking approach, it is our vision to be recognized as an organization that transforms individuals’ lives and provides families the peace of mind in knowing their loved one has a voice and a valued role in their community.

Summary of position:

The Director of Complex Health Management is responsible for strategically optimizing the integration between Columbus and its Complex Health initiatives. This role plays a crucial part in planning, coordinating, and executing operations to achieve corporate strategy and annual business objectives.

Key responsibilities include overseeing cost-effective service planning, managing consumer-directed care, and coordinating costs associated with Nursing Facility (NF) transitions under the Money Follows the Person (MFP) program. The Director ensures the effectiveness and efficiency of Complex Health Management programs across multiple states and markets by tracking, trending, and analyzing results. Additionally, this role is vital in monitoring quality measures and ensuring compliance with all relevant regulatory requirements.

Position Requirements:

1. Bachelor of Science degree or equivalent years of relevant work experience is required.
2. Minimum of five (5) years of experience in healthcare, social services, or a related field.
3. managed care or related industry experience is required.
4. Demonstrated effectiveness in leadership and management and performance experience in a managed care setting is required.
5. Project planning and project management experience is preferred.

Essential Functions:

1. Provide strategic oversight and coordination of administrative tasks across multiple states and markets, ensuring alignment with program goals and regional requirements.
2. Oversee the monitoring and tracking of participant enrollment and disenrollment in Complex Management Programs, ensuring accurate and timely reporting.
3. Develop and implement policies and procedures in line with program contract requirements, focusing on the administration of non-clinical tasks within Care Management programs.
4. Create tools to track and analyze service costs across populations, ensuring cost-effective service delivery.
5. Report on and track participants' service plans that reach significant cost thresholds, facilitating interdisciplinary meetings to address these cases.
6. Collaborate with Care Managers and team members to develop and implement optimized service plans that meet participant needs while controlling costs.
7. Ensure compliance with regulations and organizational policies by developing a person-centered consumer-directed care model that empowers individuals in their care decisions.
8. Oversee costs and planning related to Nursing Facility transitions under Money Follows the Person programs, ensuring compliance with state regulations and contract requirements.
9. Prepare and submit regular reports on cost thresholds, budget adherence, and program expenses, ensuring accuracy and timeliness.
10. Use data analytics to make evidence-based recommendations for program improvements and cost-saving measures.
11. Maintain open lines of communication with all stakeholders to ensure seamless service delivery and program success.
12. Ensure all program activities comply with relevant regulations, organizational policies, and best practices, participating in audits and reviews as needed.
13. Provide leadership and supervision to staff, ensuring effective management of administrative tasks that support Complex Health Management programs.
14. Perform any other job duties as requested.

Skills, Knowledge & Abilities:

1. Intermediate proficiency level with Microsoft Office.
2. Knowledge of full range of product requirements from regulatory, operations, clinical, reporting and compliance.
3. Critical listening and systematic thinking skills.
4. Ability to attract, manage and develop team members; Inspirational Leadership.
5. Ability to maintain confidentiality and act in the company’s best interest.
6. Oral, written, and interpersonal communication skills.
7. Leadership experience and skills.
8. Energetic, enthusiastic, and politically astute.
9. Ability to act with diplomacy and sensitivity to cultural diversity.
10. Responsive to a changing environment.
11. Health Plan Financial & Administration Management Acumen.
12. Strategic management skills.
13. Conflict resolution skills.
14. Planning, problem identification and resolution skills.

Travel/Work Environment:

1. This position is primarily remote with occasional travel based on program needs, including implementation of new programs across markets. as needed.
2. Must be able to work flexible hours, including evenings and weekends, to accommodate participant needs.