Program Director, RN

Brand New Day, HMO - Fresno, CA

30+ days agoFull-time

The Program Director, RN is responsible for assuring high quality, cost effective clinical care delivery for Brand New Day special needs programs to ensure implementation and further development of the Medicare required Model of Care. In collaboration with the Chief Medical Director, ensure effective financial management and delivery of appropriate services for symptoms, diagnosis and treatment diseases or condition.

  • Assure compliance with internal policy and external regulations.
  • Lead Change initiatives and new program developments such as Disease Management.
  • Complex Care Management and Integrated Care Team.
  • Monitor process implementation while maintain goal and growth strategies of the organization.
  • Participate on project or cross functional teams addressing organization priorities.
  • Oversees and trains staff of ”Health Coaches” / case managers;
  • Work with Registered Nurse Complex Case Managers (RN/CCMs) for most difficult cases;
  • Develops initial “Intake” process with Care Management / Leadership Team;
  • Ensures clinical (licensed) review of members’ Initial Health Risk Assessment (HRA) to stratify members into various case management levels (Complex Case Management levels):
  • Responsible for developing and implementing Model of Care for Special Needs Medicare Programs.
  • Assure management solutions for operations and clinical problems, addresses barriers to implementation of strategy and monitor corrective plan of action.

Job Type: Full-time

Experience:

  • nursing: 2 years (Required)

License:

  • registered nu (Required)