Director of Complex Care

Director of Complex Care plays a critical role in providing longitudinal cohort management programs to produce better outcomes for those with complex medical, behavioral health and social needs. As the director of Complex Care, you will play a critical role in enhancing member outcomes, optimizing care delivery, and the growth of the organization’s Complex Care program.

The Director will utilize their education, experience with, and knowledge of, models of integrated care with a primary emphasis on complex care cohort management to provide holistic, individualized, and comprehensive care management and coordination. These programs interface with health system partners, community-based organizations, and other key stakeholders.

The Director will oversee the daily operations of the child and adult complex care programs and to ensure the standards of care and practices are being delivered in accordance with state regulation, accrediting entities, and if applicable, evidence-based practice guidelines. We also expect the Director to utilize quality improvement approaches, and data analytics, in order to guide the creation, as well as delivery and evaluation of the outcomes of our programs and interventions.

Essential Functions

• Works with the Senior Director to provide strategic leadership to shape and implement the vision for Complex Care teams across children/youth and adult populations to improve the overall well-being of our members.
• Works with the Senior Director to shape and implement the Complex Care program according to state, evidence based, and accreditation mandates and requirements.
• Act as designee for Senior Director for the Complex Care program
• Responsible for the daily operational and leadership aspects of the Complex Care teams, including utilization review functions and longitudinal care management approaches.
• Collaborates closely with the adult and child CBH Utilization review directors and teams.
• Responsible for clinical data and outcomes monitoring and reporting, as well as ensuring compliance with state regulatory and accreditation requirements.
• Uses continuous quality improvement techniques to actively manage and ensure the efficacy of CBH’s complex care programs and interventions.
• Works collaboratively with the Clinical Department and other departments to research, develop and implement interventions that target applicable HEDIS performance measures.
• Use holistic and resiliency approaches to lead the complex care teams in designing comprehensive care plans that address the unique needs of each individual member, including the assessment of social determinants of health.
• Provide clinical supervision for coordinators to assess and mitigate risks associated with complex cases, ensuing timely and appropriate intervention to optimize member physical and behavioral health outcomes and safety.
• Leads problem solving for members who present with crisis issues when Supervisors and Care Managers have exhausted appropriate interventions.
• Oversee and direct several complex care teams of dedicated professionals, including care managers and other clinical staff, to ensure the delivery of high quality and patient centered, as well as recovery oriented longitudinal care management.
• Manage workforce planning including hiring, performance improvement plans, coaching, and disciplinary action in conjunction with Senior Director and Human Resources.
• Participate in intradepartmental and interdepartmental workgroups to ensure identification of opportunities for intervention collaborations, as well as improved resource management and improved communication between and among other senior leadership levels, Physician Advisors, Coordinators, and clinical staff.
• Lead clinical efforts during reviews with Office of Mental Health and Substance Abuse Services, Mercer, and National Committee for Quality Assurance.
• Organize, prepare, and disseminate clinical and quality data to be incorporated into daily decision making and to guide interventions.
• Develop new complex care programs, rooted in risk stratification and disease management for specific cohort management populations, for example, for Tier 4 eligible ICP members.
• Model and require exceptional customer service in work with members and providers.
• Develops and delivers expectations for maximum productivity of clinical staff.
• Fosters a culture of innovation and professional growth among the team members, supporting their ongoing development and engagement.
• Participates in budgeting and resource allocation processes to ensure optional utilization of resources.
• Performs other duties as assigned.
  
  

Position Requirements

• Education: Doctor of Behavioral Health (DBH) preferred such as PH.D or Psy.D in Psychology, PhD in Public Health, PhD in Health Policy; and associated doctoral degrees.
• Master’s degree in social work or related field with a minimum of 5 years of relevant leadership experience accepted.
• License/Certification: License preferred; PA Child Abuse Clearance required.
• Relevant Work Experience: Minimum of 5 years of post - graduate experience with a minimum of 5 years of supervisory experience, 2 of which would include managing through a subordinate manager. General complex Care management knowledge and some complex care experience required. Knowledge of health care policy, population health driven complex care cohort development, whole person care models and the PA Health Choices program preferred.
  
  

Skills

• Strong verbal and written communication and presentation skills
• Strong interpersonal skills to be able to build strong collaborative relationships with internal and external stakeholders, as well as complex care team staff members.
• Strong analytic skills; able to read, analyze, interpret, can create utilization and other related data reports.
• Prepare and present various PowerPoint presentation and programs, initiative and outcomes to committees, other departments, and executive leadership.
• Understanding of mental health and substance abuse services or interventions
• An interest in providing and improving services for Philadelphia’s Medicaid populations.
• General knowledge of integrated behavioral and physical health care approaches with an emphasis on complex care cohort management and policies, as well as an interest in ongoing professional development regarding these topics
• Ability to drive innovation and demonstrate knowledge of complex care industry standards, best practices, and evidence-based models to improve care delivery.
• General understanding of and familiarity with social determinants of health, as well as health disparities affecting our members.
• Familiarity with behavioral health care utilization reviews and medical necessity criteria
• Some CBH provider network knowledge preferred.
• Proficient in MS Office and able to type at least 20 words per minute.
• Strong organizational skills
• Compliant with HIPAA regulations
• Strong clinical skills
• Ability to provide clinical supervision related to clinical presentations of CBH members
• Critical thinking and proactive problem-solving abilities
• Strong leadership and team management skills fostering a positive, welcoming, culturally competent as well as productive work environment
  
  

Core Competencies

• Teamwork and Collaboration: Build and sustain relationships with co-workers and stakeholders and support efforts and deliverables. Encourage unity and help remove barriers to productivity and success.
• Respect: Treat each other and our members and stakeholders with respect and sensitivity, recognizing the importance of diversity.
• Member Centric: Focus on the needs of our members by providing value-added services, promoting strong relationships and going beyond basic expectations to achieve the best possible outcomes.
• Honesty and Integrity: Be open and honest in all we do. Maintain the highest level of integrity at all times.
• Commitment to Service Excellence: Challenge ourselves to be forward-thinking and committed to providing total member and stakeholder satisfaction, first-in-class service and high quality, innovative programs.
• Compassion and Empathy: Demonstrate a deep appreciation for another’s situation and point of view. Pay attention to emotional cues, listen effectively and show an exceptional level of caring about each person’s perspectives and circumstances.
• Problem Solving: Build and implement logical solutions to resolving challenges/issues by using individual knowledge and experience while taking resources, constraints and CBH values into consideration.
• Initiative and Self-Directed: Proactively manage time and resources in a way that ensures that all work is done in the most efficient manner while identifying and implementing initiatives without interventions from co-workers, supervisors or stakeholders.
• Flexibility and Adaptability: Adjust approaches and behaviors in order to meet the constantly changing environment head-on and accomplish CBH and individual goals. Strive to adapt to, accept and embrace change within areas of responsibility.
• Communication: Effectively and appropriately share thoughts, ideas and information - both written and oral. Respectfully listen to co-workers and stakeholders to gain a full understanding of issues/situations.
  
  

Leadership Competencies

• Strategic Thinking: Understand and integrate the long-term vision of CBH and focus current activities on what is critical to achieve future success including formulating objectives/priorities and developing and implementing breakthrough ideas.
• Leadership: Effectively manage and guide efforts to address challenges and drive continuous improvement for CBH’s programs, services and processes. Develop and implement effective strategies and appropriate interpersonal styles to influence and guide others.
• Employee Development: Recognize and promote the necessity to hire, assess, develop and retain high quality talent. Acknowledge strengths and weaknesses in team members through an ongoing performance management process that provides timely feedback in order to help them develop and enhance performance.
  
  

Work Conditions (including travel, overtime required, physical requirements and occupational exposure):

• Requires ability to travel, including out-of-state and overnight, as needed.
• Regularly requires walking, standing, stooping, bending, sitting, reaching, pushing, pulling and/or repetitive wrist/hand movements for various lengths of time throughout the day.
• Ability to utilize computers and office equipment to complete daily work responsibilities.
• Regularly works inside in areas that are adequately lighted and ventilated. Some fluctuation in temperature. No protective equipment routinely needed.
• Must be able to adapt to continuous changes/demands of the job.
  
  

Philadelphia Residency Requirement

• The successful candidate must be a current Philadelphia resident or become a resident within six months of hire.
  
  

Equal Employment Opportunity

• We strive to promote and sustain a culture of diversity, inclusion and belonging every day. CBH is an equal opportunity employer. We do not discriminate in recruiting, hiring, promotion, or any other personnel action based on all qualified individuals. This is without regard to race, ethnicity, creed, color, religion, national origin, age, sex/gender, marital status, gender identity, sexual orientation, gender identity or expression, disability, protected veteran status, genetic information or any other characteristic protected individual genetic information, or non-disqualifying physical or mental handicap or disability in each aspect of the human resources function by applicable federal, state, or local law.
  
  

Requesting An Accommodation

• CBH is committed to providing equal employment opportunities for individuals with disabilities or religious observance, including reasonable accommodation when needed. If you are hired by CBH and require an accommodation to perform the essential functions of your role, you will be asked to participate in our accommodation process. Accommodations made to facilitate the recruiting process are not a guarantee of future or continued accommodation once hired.
• If you would like to be considered for employment opportunities with CBH and have accommodation needs for a disability or religious observance, please send us an email at CBH.Recruitment@Phila.gov