This role will ensure integration across all parties at Boston Medical Center Health System, including healthplan operations at Boston Medical Healthnet plan, clinical delivery at Boston Medical Center and other provider partners, and other affiliates to ensure that all areas of the BMC continuum are able to seamlessly meet the needs of the members. Specific responsibilities will include: enhancing co location of Care Management programs, development of robust primary care and community-based care management programs, establishing contracts with key vendors to improve the accessibility to community based services, and enhancing integration into the hospitals to optimize transitions of care.
The VP Clinical Operations, Population Health will be a senior clinical leader in the organization. This role will serve as the clinical leader when establishing and maintaining relationships with key community partners, i.e. ASAP's and ILC's. This role will partner with other clinical leaders to engage and hold complex care management programs accountable for quality, clinical, and financial outcomes. In partnership with Physician leaders, this role will provide clinical oversight and direction to care management teams and program leaders.
In addition to clinical responsibilities, this position will partner with other administrative leaders to manage other key performance domains in CCM programs, including quality, risk adjustment, and operational efficiency. For example, this role will be accountable ensuring that appropriate state mandated assessments are accurately completed in a timely manner. The role will also ensure that opportunities for risk adjustment are seamlessly incorporated into existing care management programs.
This position oversees all complex care management teams in the Massachusetts ACO, MCO, and SCO programs, and the New Hampshire MCO program. Successful candidates will have extensive experience and deep clinical knowledge of patients with complex medical, social and behavioral health conditions. In addition, successful candidates will have direct clinical or programmatic experience with dual eligible populations.
- Strategically plans care management (CM) models for new products, new projects and shifts in business priorities consistent with population health modeling and short and long term strategic goals of the Plan.
- Instrumental in generating medical expense savings, improving financial performance including ongoing monitoring of metrics and cost savings across products and adjusts design and staffing based on regional and product variations.
- Works to establish alignment between the delivery system and community outreach initiatives and coordinates closely with Plan and ACO leaders with value-based payment models.
- Plans and implements programmatic changes for both the Plan and integration of CM at the Boston Medical Center (BMC) for special hospital projects to meet shared system goals. Utilizes experience with the Boston Medical Center Health System (BMCHS) and its ACO outside of the health system relating to population health delivery and operations.
- Conceptualizes, designs and implements programs that integrate complex care, long term services and supports, care management/disease management, care transitions, and care coordination consistent with both contractual requirements and the needs of (internal and external) customers.
- Participates as a senior member of the Plan and Office of Clinical Affairs (OCA) strategic planning and management team.
- In conjunction with the VP Quality and Clinical Program Oversight, director of CM, and director of pharmacy ensures the clinical population health programs consistently meet and/or exceed quality standards needed for accreditation and CMS Star ratings.
- Is responsible to ensure that each staff member receives the appropriate supervision, and professional development. Directs director to implement and carry out the related training and mentoring tasks.
- Monitors trends and reports in order to implement process improvement strategies focused on efficiencies, effectiveness, productivity, and outcomes. Recommends and pursues administrative and process simplification designed to reduce waste, re-work and redundancy.
- Through collaboration with other departments and health system functions, promotes the appropriate coordination and delivery of quality medical care, member outreach, and care management strategies across the network and provider community. Initiates, supports and coordinates clinical service transformation designed to reduce fragmented care delivered in silos and increase continuity of care for members while reducing health disparities.
- Ultimately responsible for success and overall compliance of the Population Health/Care Management department.
- Works closely with the leadership of OCA to assure communication and operational integration within the Plan.
- Develops and manages department operational budget. Oversees hiring decisions as appropriate.
- Coordinates services between regional offices to provide consistent services statewide.
- Other functions as required to support departmental and Plan activities.
Competencies, Skills, and Attributes:
- Strong understanding of healthcare, medical delivery and medical management.
- Experience in program development and/or health policy. Experience with Medicaid and Medicare population preferred.
- Strong oral and written communication skills; ability to interact within all levels of the organization as well as with external contacts.
- Knowledge of analytics, metrics, and an ability to interpret data.
- Effective collaborative and proven process improvement skills.
- Requires strong leadership and people leadership competences.
- Ability to understand and synthesize data as it translates to care management related programmatic implications.
- Competence with standard Microsoft Office applications, particularly MS Outlook and MS Word, and other data entry processing applications.
- Demonstrated ability to successfully plan, organize and manage programs and projects.
- RN or NP strongly preferred
- Masters degree in other health services field may be considered
- Minimum 10+ years managed care experience including a minimum of 7 years prior supervisory experience
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