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Director, Integrated Care Team (ICT) Care Coordination

AmeriHealth Caritas

Southfield, MI(remote)

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JOB DETAILS
SKILLS
Analysis Skills, Behavioral Health, Best Practices, Case Management, Certified Case Manager (CCM), Clinical Medicine, Communication Skills, Contract Requirements, Corrective Action, Department of Health and Human Services, Disease Prevention and Control, Diversity, External Quality Review Organization (EQRO), Federal Contracts, Health Plan Membership, Healthcare, Healthcare Providers, Leadership, Maintain Compliance, Managed Care, Market Analysis, Market Share, Market Tracking, Medicaid, Microsoft Excel, Microsoft Office, Microsoft PowerPoint, Microsoft Word, Multitasking, National Committee for Quality Assurance (NCQA), Nursing, Operational Measurement, Operational Strategy, Operations Management, Operations Planning, People Management, Performance Management, Performance Metrics, Process Improvement, Project/Program Coordination, Purchasing/Procurement, Quality Assurance, Quality Management, Quality Metrics, Registered Nurse (RN), Regulations, Regulatory Compliance, Request for Proposals (RFP), Social Work, State Laws and Regulations, Strategic Planning, Team Lead/Manager, Team Player, Willing to Travel
LOCATION
Southfield, MI
POSTED
8 days ago
Role Overview: The Director, ICT Care Coordination, is responsible for leading the strategic direction, operational execution, and performance of care coordination and population health programs within the assigned market to ensure the delivery of high-quality, compliant, and member-centered clinical and non-clinical services.


Work Arrangement:


+ Remote – Fully remote associate must be located in Michigan (MI).

+ Some travel to state and other meetings will be required


Responsibilities:


+ Partner with the Market Chief Medical Officer (CMO) and other market leaders to develop, execute, and monitor the plan’s population health strategy while supporting equitable, whole-person care for members.

+ Collaborate with CMO, Quality Director, and other market leaders and evaluate continuous quality improvement and process optimization efforts across care coordination programs and initiatives

+ Oversee market-specific clinical programs, including Case Management (CM), Bright Start Maternity program, and Community Outreach

+ Ensure alignment of care coordination programs with population health strategy, enterprise policies, and contractual requirements

+ Direct and oversee Care Coordination – Integrated Care Team (ICT) clinical and non-clinical staff; support staffing, hiring, and professional development

+ Ensure compliance with state, federal, and contract requirements, including the Michigan Department of Health & Human Services (MDHHS) contract

+ Implement processes for identifying, assessing, and developing care plans for members with special healthcare needs

+ Ensure coordination of care across physical health, behavioral health, and community-based services

+ Serve as the primary point of contact with state regulatory agencies on care coordination-related activities

+ Develop and implement engagement strategies for members

+ Ensure effective coordination of services across multiple healthcare entities and providers

+ Drive integration of care coordination and disease management within population health and quality improvement initiatives

+ Lead performance measurement efforts to assess and improve health outcomes and operational effectiveness

+ Monitor transition of care programs and care coordination quality performance metrics; implement corrective actions as needed

+ Serve as liaison between market and enterprise leadership; share best practices and align strategies

+ Partner with regulatory, external quality review organizations such as (but not limited to) the National Committee for Quality Assurance (NCQA), and Quality Assessment and Performance Improvement (QAPI) teams

+ Prepare and deliver reporting, including key performance indicators (KPIs), program performance, and utilization trends

+ Support procurement activities (RFPs/RFIs) and provide subject-matter expertise for care coordination and population health expansion efforts

+ Perform other duties as assigned


Education & Experience:


+ Master’s degree in Nursing with an active, unrestricted Registered Nurse (RN) licensure in MI required

+ Bachelor's degree in Nursing with an active, unrestricted RN licensure in MI and a Master's degree in health services research, health policy, or other relevant field required.

+ Master’s degree in Social Work with an active, unrestricted Licensed Master’s Social Worker (LMSW) licensure in MI required

+ 3 to 5 years of progressive management experience, including staff management, within a Medicaid managed care environment

+ 3 years of experience leading case management programs, including program design, implementation, and strategic execution

+ 3 years of experience with NCQA standards and regulatory guidelines

+ Certified Case Manager (CCM) certification required

+ Experience developing, driving, and measuring clinical operations, population health strategy, and performance improvement initiatives preferred


Licensure:


+ Active, unrestricted RN licensure or LMSW in MI.


Skills & Abilities:


+ Strong leadership and team management skills with the ability to lead multidisciplinary clinical and non-clinical teams

+ Deep understanding of population health, care coordination, and managed care operations

+ Knowledge of Medicaid regulations, state contract requirements, and compliance standards

+ Proven ability to design, implement, and optimize clinical programs and operational workflows

+ Strong analytical and performance management capabilities with a focus on outcomes and quality improvement

+ Excellent communication and collaboration skills, with the ability to engage executive leadership and external stakeholders

+ Ability to manage multiple priorities and drive execution in a complex, highly regulated environment

+ Strategic thinker with the ability to translate population health goals into actionable operational plans

+ Proficiency in Microsoft Office Suite (Word, Excel, PowerPoint)
As a company, we support internal diversity through:

Recruiting. We are an equal opportunity employer. We do not discriminate on the basis of age, race, ethnicity, gender, religion, sexual orientation, or disability. Our inclusive, equitable approach to recruiting and hiring reinforces our commitment to DEI.

About the Company

A

AmeriHealth Caritas

Leaders in health care solutions for those most in need

AmeriHealth Caritas is the nation's leader in providing comprehensive health care solutions for those in most need and the chronically ill. We impact the lives of more than 5.7 million members nationwide. With more than 30 years of experience managing care for individuals and families in publicly-funded programs, we have become known for developing innovative solutions that help improve health outcomes while reducing costs.

Our mission, our goal

Our mission is to help people get care, stay well and build healthy communities. Our goal is to provide responsible managed care solutions, including Medicaid, Medicare, and CHIP - plus behavioral health, pharmacy benefits management and third-party management and administrative services.

COMPANY SIZE
5,000 to 9,999 employees
INDUSTRY
Healthcare Services
FOUNDED
1985
WEBSITE
http://www.amerihealthcaritas.com