Director of Care Management & Navigation

At York Hospital, we're more than a hospital. We are a team of providers, clinicians and staff members offering expertise within a Hospital setting, our community sites, and physician practices located throughout Southern Maine and the NH seacoast. Our caregivers' commitment is to make a positive difference in the lives of one another, our patients and our community by instilling our vision of Loving Kindness for all.
York Hospital, we are a Community. For Life.
We currently have an opportunity for an experienced Director of Care Management & Navigation. This is a new full time position in Care Management and is located in York, Maine
The Director of Care Management & Navigation plays a vital role in ensuring the success of the Patient Experience by providing a strategic direction and oversight of the day to day operations of the Care Management and Navigation Teams.
Responsibilities include:
Develops and implements the organization s utilization management plan in accordance with the mission and strategic goals of the organization and federal and state law and regulations.
Develops and implements systems, policies and procedures for prospective, concurrent and retrospective case review, clinical practice guidelines, care maps, clinical protocols, and reporting quality of care issues identified during the utilization review process
Collaborates with Leadership to evaluate medical trends and develop Medical Management and Quality Improvement initiatives to result in improved quality, achievement of health benefit ratio targets, and reduction in administrative costs. Directs the development and implementation of policies & procedures, work processes, financial reporting, compliance, systems, metrics are established and measured and monitoring and driving improvement to metrics in the Navigation and Care Management teams.
Research and develop business plans to leverage technology to increase effectiveness and efficiency
Standardized training, auditing, and work processes for new and existing UM business to promote consistency and to avoid redundant effort
In order to help us continue to provide exceptional patient experiences, we need candidates with the following:
Registered Nurse (BSN or MSN)
Must have 5 years of Case Management experience and 3 or more years in a Management role
Exceptional communication skills, verbal and written.

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