Medical Director- Population Health

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• The Medical Director of Transitional Care leads the Illinois Transitional Nursing team and supports national initiatives to improve care coordination across multidisciplinary teams. This role ensures high-quality, patient-centered transitions from inpatient to outpatient settings, aiming to reduce readmissions and enhance satisfaction. Responsibilities include team oversight, program development, compliance monitoring, and data-driven decision-making. The ideal candidate is a licensed RN with strong leadership, clinical, and communication skills, and experience in transitional nursing, discharge planning, or home health.

• Job Description

  Role
  
  Description:

  The Medical Director, Transitional Care, APP is responsible for leading the IL Transitional Nursing team as well as providing programmatic support to national leadership and transitional staff. The Transitions of Care program focuses on providing a multi-disciplinary connection between Care Navigation, Utilization Management, facility, local care teams and patient/family. The Manager role provides leadership in executing the Transitions of Care program goals which include ensuring high-quality, patient-centered care;
  
  preventing avoidable readmissions; and managing efficient resource utilization and improving patient and provider satisfaction.

  Responsibilities:
  • Serving as the Subject Matter Expert on Transitions of Care
  • Leading the IL market Transitional Care team including the oversight of daily operations, maintaining regional/facility assignment, balancing of staff caseloads, monitoring team/individual performance and coaching staff when appropriate, providing coverage and support as needed.
  • Providing direct or supporting efforts in the hiring and training of Transitional Care staff in new and existing markets
  • Assisting the department of Medical Management in the development, execution and improvement of the Transitions of Care program
  • Helping all markets resolve specific needs as related to Transitional Care navigation
  • Executing effective collaboration between multi-disciplinary teams including but not limited to:
    Care Navigation, Utilization Management, facilities, local care teams and patient/family
  • Having firm knowledge and executing CMS, state-specific and NCQA compliance criteria as related to Transitions of Care
  • Monitoring data related to patient cost, admissions, post-discharge appointment completion and health outcomes to help guide and direct Transitions of Care program initiatives and goals
  • Participates in daily inpatient and post-acute rounding calls with Care Navigation and UM teams to help determine patient status and appropriate discharge plan
  What we are looking for:
  • Education:
    
    Bachelor degree in Nursing required, Master's degree preferred
  • Experience:
    
    >7 years or relevant experience with a minimum 2 years of direct supervisory experience and 2+ years of experience in transitional nursing, discharge planning or home health
  • Registered Nurse (RN) license in good standing with no restrictions required.
  • Nurse Case Management Credentialing (RN-BC) or Certified Case Manager (CCM) preferred
  • Experience in utilization management
  • Knowledge of Medicare/Medicaid and NCQA regulatory transitions of care criteria
  • Strong clinical and assessment skills
  • Outstanding verbal and written communication skills
  • Ability to work independently and maintain flexibility in a fast-paced, start-up environment
  • Ability to analyze data and use it to improve care delivery
  • Self-starter with a high level of accountability and responsibility for the outcome of care
  • Highly organized and able to manage multiple priorities appropriately
  • Independent problem-solving skills
  • Able…