The Director of Care Transitions serves as the primary program lead for the Facility-Based Care Management team within the Care Management department. The Director of Care Transitions is responsible for directing the specialized support provided to members with complex physical and behavioral health needs while transitioning between care facilities. The Director of Care Transitions ensures clinical and operational excellence in care transition activities, focusing on maintaining continuity of care across various healthcare settings and provider models.
This position will allow the successful candidate to work a schedule that will be primarily remote. While there is no expectation of being in the office routinely, they will be required to come into the Alliance Office for business and team meetings as needed.
Responsibilities & Duties
Manage and Develop Staff
- Work with Human Resources to attract, maintain, and retain a highly qualified and well-trained workforce
- Ensure staff are well trained in and comply with all organization and department policies, procedures, and business processes
- Provide direct clinical and administrative supervision of team members. This may include routine clinical review of cases, interpretation of census data, and advising team members regarding outreach to network providers regarding cases where care teams are engaged
- Organize workflows and ensure staff understand their roles and responsibilities
- Ensure the department has the needed tools and resources to achieve organizational goals and to support employees and ensure compliance with licensure, regulatory, and accreditation requirements
- Actively establish and promote a positive, diverse, and inclusive working environment that builds trust
- Ensure all staff are treated with respect and dignity
- Ensure standards are transparent and applied consistently, impartially, and ethically over time and across all staff members
- Work to resolve conflicts and disputes, ensuring that all participants are given a voice
- Set goals for performance and deadlines in line with organization goals and vision
- Effectively communicate feedback and provide ongoing coaching and mentoring to staff and support a learning environment to advance team skills and professional development
- Cultivate and encourage efforts to expand cross-team collaboration and partnership
Oversee Department/Unit Operations
- Guide efforts of care teams in supporting members with service engagement, assessing impact and seeking resolution of disparities regarding social determinants of health, monitoring census risk stratification for changes that will impact overall management of cases served
- Monitor program dashboard and other departmental reports and respond to risks identified
- Oversee development of educational materials for members regarding risks/benefits of physical health and/or behavioral health related services if needed in collaboration with community/network providers
Program Leadership & Clinical Oversight
- Lead the Facility-Based Care Management team in supporting members with complex physical and behavioral health needs
- Establish behavioral and physical health outcome targets for the Facility Based Care Managers
- Manage specialized transition initiatives for facility-based members, including those in SNF, hospital, crisis, and ADATC settings
Care Transition Management
- Oversee all Plan-to-Plan and PLE-to-PLE transition activities
- Ensure continuity of care and minimize service gaps during member transitions
Strategic Alignment & Collaboration
- Coordinate with Provider Network Directors to align physical health outcomes with Care Management Agencies and Advanced Medical Homes (AMH)
- Collaborate interdepartmentally to implement a cohesive, whole-person care model
- Align departmental processes to ensure coordinated service delivery for both members and staff
Develop Policies, Procedures, Processes, and Workflows
- Use a care management approach when developing policies, procedures and workflows which impact the work of the department
- Collaborate with Medical Management team on development and implementation of clinical decision-making workflows. Analyze care management trends and collaborate with Medical Management on interpretation and business action steps
- Develops workflow and collaborates across Alliance departments to understand data from a variety of sources as this relates to the physical health care risk and need for support of members served
Collaborate with Internal Departments and External Stakeholders
- Represent the Transition of Care and/or Care Transitions in Network provider-related performance discussions to ensure agreement of desired outcomes across care teams, CMA and AMH+ care management models. This may include collaboration with hospitals and other behavioral health inpatient and/or physical inpatient units within the Alliance Health network
- Lead consultation and outreach to community based physical health and behavioral health providers serving members with care team involvement
- Maintain effective interpersonal relations with Alliance staff, providers, partners and community stakeholders
Minimum Requirements
Education & Experience
Required:
Master's degree from an accredited college or university in mental health, public health, social work, psychology, education, sociology, business or public administration and five (5) years of experience in a community, business, or governmental program in health-related fields, social work, or education, including three (3) years of supervisory, consultative or administrative experience;
Or
Graduation from an accredited school of nursing and seven (7) years of experience in a community, business, or governmental program in health-related fields, social work, or education, including three (3) years of supervisory, consultative or administrative experience.
Active NC Clinical License LCSW, LMFT, LCMHC, LPA, or RN is required.
Preferred:
Experience in a physical health and/or behavioral health setting working with diverse populations preferred.
Experience in Utilization Management or discharge planning is preferred.
Knowledge, Skills, & Abilities
- Thorough knowledge of discharge planning, services/interventions for individuals with physical health, intellectual/ developmental disabilities, traumatic brain injury, mental health, and/or substance use disorders
- Thorough knowledge of whole person care and population health approaches to care management
- Problem solving and program analysis skills to assist in implementation and evaluation of programs and pilot projects
- Proficient with Microsoft Office software and familiarity with data analytics programs and reporting
- Strong oral and written communication skills.
- Change Management skills
- Exceptional interpersonal skills,
- Detail oriented and able to independently organize multiple tasks and priorities and effectively manage under pressure of deadlines.
- Ability to build and maintain positive relationships with internal and external customers and stakeholders.
Salary Range
$119,264 - $152,062/ Annual
Exact compensation will be determined based on the candidate's education, experience, external market data and consideration of internal equity
An excellent fringe benefit package accompanies the salary, which includes:
- Medical, Dental, Vision, Life, Long Term Disability
- Generous retirement savings plan
- Flexible work schedules including hybrid/remote options
- Paid time off including vacation, sick leave, holiday, management leave
- Dress flexibility
Want to learn more about what it's like work as part of the Care Management Team? Click on our video to learn more: https://youtu.be/1GZOBFx61QU
