Director of Nursing

The Director of Clinical Intake oversees all clinical activities involved in the Intake process for participants and holds ultimate responsibility for evaluating and determining the clinical eligibility of prospective participants for enrollment.

JOB RESPONSIBILITIES:

• Lead efforts in continuous quality improvement to enhance staff performance and achieve optimal participant outcomes.
• Oversee and approve the authorization of personal care hours in collaboration with the Care Delivery Department, ensuring alignment with participant needs and Medicaid regulations.
• Work with the Market Engagement team to analyze referral trends, improve conversion rates of suitable candidates, and enhance the quality of enrollments.
• Collaborate with Care Delivery leadership and team members to provide significant clinical information ahead of enrollment for a seamless transition and effective preparation for complex cases.
• Partners with Care Delivery by meeting with site leadership and IDT to provide Intake updates, address concerns and improve overall process.
• Serves as clinical point of contact for Care team regarding question, concerns or issues arising after enrollment.
• Develop and analyze reports related to the clinical component of the Intake process to assess and improve enrollment quality.
• Ensure Clinical Intake Managers and Intake Assessment Managers maintain accurate, timely, and appropriate documentation in compliance with departmental and governmental requirements.
• Maintain expertise in Medicare and Medicaid regulations, providing relevant updates to staff and stakeholders as needed.
• Engage in staff development by creating and delivering training materials and continuing education programs for team members.
• Manages relationship with contracted agencies. Includes general oversight of day-to-day operations, providing supervisory oversight of agency contracted nurses, obtaining regular vendor staffing updates so required documents are supplied to HR, reconciling invoices to ensure accuracy and approving payment to vendor, participating in strategic meetings involving contractual agreements and working process
• Develop and implement departmental policies, procedures, and workflows, presenting them to committees for approval.
• All other duties as assigned

Schedule: 8:30AM – 5:30PM

Weekly Hours: 40

QUALIFICATIONS:

Education: BS in Nursing or other health-related area preferred.

Experience:

• Minimum five (5+) years of experience in care/case management, disease management, population health management, utilization review, quality assurance or discharge planning (preferably within a managed care, home care or community health organization)
• Minimum two (2+) years of experience in MLTC/Managed Care with preparation of Uniform Assessment System of New York (UAS-NY)
• Experience with Customer Relationship Management platforms and clinical management systems