Director, Care Management Delegation - Center of Excellence

Job Description:

About the Role:

The Director, CMD COE is accountable for managing delegated Care Management requirements (either regulatory requirements or NCQA standards, depending on client) and managing compliance risk to delivering those requirements.
 

Responsibilities:

• Care Management Audit Execution: Deliver a playbook for Client and Regulatory audit presentation readiness and execution.

• Client Inquiry Response: Ensure Clients have a clear primary point of contact for CMD topics and inquiries are responded to promptly.

• Implementation and Change Management: Review and document new regulatory requirements and their impacts to operations to stakeholders; partner with Legal on law interpretations; consult with Product and Market launch teams to ensure solutions meet requirements.

• Gap Closure & Corrective Action Plans: Support Markets understanding root cause of CMD compliance gaps, identifying action plans to close gaps, and monitoring efficacy of plans in bringing operations into compliance.

• Independent Oversight: Develop and execute customized monitoring programs, using a combination of administrative reporting and sample-based reviews, designed to detect that key CMD requirements are being met within each Market. Ensure results of the program are communicated to stakeholders in an actionable manner.

• Cross-Functional Collaboration: Promote an organizational understanding of compliance issues, laws, and regulations, as well as the operational consequences of non-compliance.

Requirements:

• 8+ years in a healthcare compliance role or related field within the healthcare industry (Medicaid experience is highly preferred).

• Familiarity with Medicare Managed Care Coordination of Care regulations and related NCQA standards.

We take into account an individual’s qualifications, skillset, and experience in determining final salary. This role is eligible for health insurance, life insurance, retirement benefits, participation in the company’s equity program, paid time off, including vacation and sick leave. The actual offer will be at the company’s sole discretion and determined by relevant business considerations, including the final candidate’s qualifications, years of experience, skillset, and geographic location. The expected salary range for this position is: 

Cityblock values diversity as a core tenet of the work we do and the populations we serve. We are an equal opportunity employer, indiscriminate of race, religion, ethnicity, national origin, citizenship, gender, gender identity, sexual orientation, age, veteran status, disability, genetic information, or any other protected characteristic.

We do not accept unsolicited resumes from outside recruiters/placement agencies. Cityblock will not pay fees associated with resumes presented through unsolicited means.