Morgan Consulting Resources, Inc. has been retained by Community Health Plan of Washington to conduct the search for an experienced Director of Care Management, Medicaid . This is a remote position with periodic travel to the home office in Seattle.

About Community Health Plan of Washington

For nearly 30 years, Community Health Plan of Washington (CHPW) has been providing quality health care to Washington families and supporting their choices for health care. CHPW's coverage is geared toward a model of care that treats the whole person and fosters trust, compassion, respect, and equality.

Mission: "Our mission is to deliver accessible managed care services that meet the needs and improve the health of our communities, and make managed care participation beneficial for community-responsive providers. We work for patients, and we work to help providers better serve those patients.

About the Director of Care Management, Medicaid

Reporting to the Senior Director of Care Management, the Director of Care Management, Medicaid is responsible for the direction and coordination of care management activities to manage the care of the member over the continuum of care, including both physical and behavioral health services, for the Medicaid line of business.

Position Responsibilities Oversees assigned programs, including development, audits, quality monitoring, and reporting Defines strategies for identifying and managing high-risk members Designs processes and goals for medical and behavioral health care management Partners with internal teams to analyze program effectiveness and guide interventions Leads development and analysis of care management metrics tied to organizational goals Identifies opportunities for improvement based on clinical and service data analysis Essential Knowledge, Skills & Abilities Skilled in designing and launching new programs and teams Proven ability to lead large teams and drive results through others Experienced in testing and implementing innovative solutions for special populations Strong understanding of managed care components and their integration Applies quality improvement methods to enhance processes Creates a positive work environment with feedback and staff development Required Qualifications Bachelor's degree in nursing or a master's degree in social work RN or LSWAA or LSWAIC in the state of WA, as applicable Case Management Certification (CCM or ACM or C-ASWCM or CMGT-BC) 5+ years progressive experience working with medical or behavioral case management 7+ years progressively responsible management experience in the areas of case management or population health or disease management About CHPW's Culture

"Our Mission is our North Star, an overarching purpose carried out through our strategic goals. Our Values, orient us toward them; they influence our behaviors, actions, and priorities. Values by their nature are aspirational and serve as core principles. They give us a sense of purpose and direction, setting the tone for our daily interactions with each other. We are committed to the ongoing process of making our values a lived reality by infusing them into all aspects of how we lead and work together. Our shared values include: We Center Our Communities We support the communities we serve, our colleagues, and those we partner with, by giving each person what they need to thrive. We Aim Towards Justice We champion inclusive behaviors to help build bridges across our differences in the pursuit of building fair systems and practices. We Build Trusting Relationships We embrace collaboration by inviting in more voices, and actively listening to them, to improve our teamwork and achieve our goals. We Own Our Actions We strive to do the right thing by holding ourselves accountable to the communities we serve, to each other, and to ourselves.

Compensation and Benefits

The Director of Care Management, Medicaid is eligible for a 15% annual incentive target based on company, department, and individual performance goals. The base pay offered will consider internal equity and may vary depending on the candidate's job-related knowledge, skills, and experience among other factors. Expected pay range of $145,000-$165,000. Explore CHPW's full benefits at https://chpwbenefitshub.com/.

CHPW offers the following benefits for Full and Part-time employees and their dependents: Medical, Prescription, Dental, and Vision Telehealth app Flexible Spending Accounts, Health Savings Accounts Basic Life AD&D, Short and Long-Term Disability Voluntary Life, Critical Care, and Long-Term Care Insurance 401(k) Retirement and generous employer match Employee Assistance Program and Mental Fitness app Financial Coaching, Identity Theft Protection Time off including PTO accrual starting at 17 days per year. 40 hours Community Service volunteer time 10 standard holidays, 2 floating holidays Compassion time off, jury duty Contact information:

Erica Eikelboom, Principal & Executive Search Consultant erica@morganconsulting.com

More position details:

Responsible for the direction and coordination of care management activities to manage the care of the member over the continuum of care, including both physical and behavioral health services, for assigned lines of business. These activities include proactive identification of members in need of care management services, application of case management for identified members, care coordination and condition-specific management for certain populations with an emphasis on equity. The focus is on supporting access to medically necessary and high quality of care and efficient utilization of available healthcare resources, facilities and services and collaboration with community programs and agencies for effective utilization of social services in the community. This role encompasses the effective and efficient management of human, fiscal and other resources, development of staff competency through assessment and education, compliance with regulatory and professional standards and strategic planning, improvement of quality, service levels, safety, customer satisfaction and of collaborative relationships within CHPW and CHNW. Essential functions and Roles and Responsibilities: Designs and implements systematic and comprehensive care management policies and procedures that ensure high quality care management application to positively impact member outcomes. Administers and ensures care management programs meet compliance and regulatory standards as required by Centers for Medicare & Medicaid Services (CMS), DSNP Model of Care (MOC), Washington Health Care Authority (HCA), and/or National Committee on Quality Assurance (NCQA) for continued accreditation of the health plan, as well as state and federal regulations, quality metrics and evolving models of care. Provides oversight of programs within assigned lines of business including development, implementation of program components, quality data collection and monitoring, auditing of program requirements and reporting outcomes to appropriate leadership and committees. Responsible for a strong understanding of health plan benefits for all lines of business. Defines strategy to identify and assess outlying and high-risk cases to determine plan of care. Develops and designs procedures, processes, productivity targets, quality of care and financial goals, and new delivery models for medical and behavioral health care management. Collaborates with Medical Directors, Healthcare Analytics, Network Management and other departments as needed to collect, analyze, and report on effectiveness of programs and address quality of care issues. Uses data to guide the development and implementation of health care interventions that improve value to the member. Collaborates with internal leaders to deploy a coordinated regional approach to member and provider services in each region across the state. Drives strategy for the development, reporting, monitoring, and analysis of department measures that are linked to organizational goals especially as pertains to achieving enrollment targets in care management programs and return on investment projections on care management programs. Works collaboratively with other members of the Clinical Services Leadership Team to establish mechanisms and processes to regularly analyze the different Plan populations for variances in clinical and service quality to identify and recommend the highest impact opportunities and department-level strategies for interventions. Delegates responsibilities to managers and provides professional development opportunities for team leaders. Provides leadership in developing, implementing, and communicating short and long-range plans, goals, and objectives for clinical teams. Aligns team goals with the organization's vision and strategy. Evaluates and integrates Community Health Center processes and programs to ensure that resources are being maximized to improve member care and reduce duplication of work within CHPW. Responsible for ensuring the day-to-day supervision of divisional staff including identifying staffing and resource needs, effective hiring, appropriate performance management, staff development, with the goal of developing a cohesive, empowered, and productive work environment. Responsible for annual budget preparation and monitoring expenses within the department. Participates and/or Chairs/Co-Chairs on committees as assigned Employees are expected to report to work as scheduled, participate in all assigned meetings, and meet established performance and accountability standards. Other duties as assigned; essential functions listed are not necessarily exhaustive and may be revised by the employer, at its sole discretion. Knowledge, Skills, and Abilities: Experience with designing and deploying new programs and teams. Demonstrated ability to effectively lead and manage large staffs, including the ability to achieve results through others. Experience with identifying, testing and implementing innovative concepts that support special population needs. Knowledge of the various components of managed care (quality improvement, disease management, population management, utilization management, and case management) and how they link. Actively uses and supports quality improvement principles and methods in an effort to improve inter- and intra-departmental processes. Strong project management skills, including the ability to implement new programs and products. Excellent 'customer service' attitude in relationships with enrollees/patients, staff and external partners. Highly effective communicator orally and in writing, with the ability to translate strategy into action. Fosters an effective work environment and ensures employees receive recognition, feedback and development. Ability to relate and interact with staff at all levels of the organization; exercises sound judgment, builds strong working relationships and demonstrates diplomacy, professionalism, and appropriate confidentiality in dealing with others. Strong analytical and problem-solving skills. Articulates organizational vision and implements strategic initiatives, with the ability to identify systemic issues to promote real change. Working knowledge of M/S office (Word, Excel, Access). Knowledge of regulatory and certification requirements and their impact on the organization (for example, HEDIS, CAHPS, and NCQA). Perform all functions of the job with accuracy, attention to detail and within established timeframes.

Travel Required: Up to 25% local travel to meet with community partners. Community Health Plan of Washington is an equal opportunity employer committed to a diverse and inclusive workforce. All qualified applicants will receive consideration for employment without regard to any actual or perceived protected characteristic or other unlawful consideration.