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Manager of Accountable Care Transformation and Care Management

Location: Boston, MA
Post Date: 4/2/2020
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The Manager of Accountable Care Transformation and Care Management supervises care management activities across clinical sites that are part of a Boston Medical Center Health System Accountable Care Organization. Boston Medical Center Health System and their affiliated partners include a mix of academic medical centers, community hospitals, and community health centers across Greater Boston, Western Mass, and Southern Mass. In partnership with BMCHP, clinical sites are collectively sharing risk for Medicaid patients as part of the new MassHealth initiative to transform healthcare via formation of Medicaid ACOs. In order to succeed in the Medicaid ACO, BMCHS is rapidly designing and implementing a number of medical management programs to manage utilization and total cost of care, specifically for patients with the highest levels of risk and healthcare utilization. There will be several Managers of Accountable Care Transformation and Care Management across the BMCHS network. Managers will report to a Director of Care Management. The Manager directly oversees front-line care management (CM) staff working in medical management programs. These programs include, but are not limited to: primary care-based complex care management, ED-based care management, Readmissions Care Team, and Quality Improvement. BACO’s ACO Care Management activities are not like traditional telephonic care management programs run by health plans – the Care Management programs are designed to be closely integrated with patient care teams, so all care management activities take place at the site of care, either in the Primary Care Office or in the ED or Inpatient floors at a hospital. As such, the manager will spend the majority of his/her time at clinical sites, interacting directly with the CM teams, as well as the local ED, Inpatient, and Primary Care teams. Care Management teams are comprised of Nurses and Community Wellness Advocates (CWAs), and may include social workers as well. The Manager will oversee staff in both roles and will collaborate with multi-disciplinary team members including pharmacists, behavioral health professionals, and others. The Manager will be responsible for building a high-performing care management team. He/she will recruit, hire, and onboard staff who are passionate about social justice, caring for vulnerable patients, and clinical excellence. Given that staff may be located in multiple sites across BACO, it will be critical for the managers to build a team culture and sense of community that overcomes geographic separation across team members. He/she will be responsible for continuous improvement of the care management process, as well as the continued growth and development of his/her team. The Office of Mission at Boston Medical Center will be a close collaborator in the hiring, management, and culture-building efforts for the Community Wellness Advocates. The Manager will be expected to partner closely with the leadership team in the Office of Mission. Compensation will be salary plus incentive based on performance against managing total cost of care.

The Manager of Accountable Care Transformation and Care Management supervises care management activities across clinical sites that are part of a Boston Medical Center Health System Accountable Care Organization. 

Boston Medical Center Health System and their affiliated partners include a mix of academic medical centers, community hospitals, and community health centers across Greater Boston, Western Mass, and Southern Mass.  In partnership with BMCHP, clinical sites are collectively sharing risk for Medicaid patients as part of the new MassHealth initiative to transform healthcare via formation of Medicaid ACOs.   In order to succeed in the Medicaid ACO, BMCHS is rapidly designing and implementing a number of medical management programs to manage utilization and total cost of care, specifically for patients with the highest levels of risk and healthcare utilization.  There will be several Managers of Accountable Care Transformation and Care Management across the BMCHS network.  Managers will report to a Director of Care Management.

The Manager directly oversees front-line care management (CM) staff working in medical management programs.  These programs include, but are not limited to: primary care-based complex care management, ED-based care management, Readmissions Care Team, and Quality Improvement.  BACO’s ACO Care Management activities are not like traditional telephonic care management programs run by health plans – the Care Management programs are designed to be closely integrated with patient care teams, so all care management activities take place at the site of care, either in the Primary Care Office or in the ED or Inpatient floors at a hospital.  As such, the manager will spend the majority of his/her time at clinical sites, interacting directly with the CM teams, as well as the local ED, Inpatient, and Primary Care teams.  Care Management teams are comprised of Nurses and Community Wellness Advocates (CWAs), and may include social workers as well.  The Manager will oversee staff in both roles and will collaborate with multi-disciplinary team members including pharmacists, behavioral health professionals, and others.

The Manager will be responsible for building a high-performing care management team.  He/she will recruit, hire, and onboard staff who are passionate about social justice, caring for vulnerable patients, and clinical excellence.  Given that staff may be located in multiple sites across BACO, it will be critical for the managers to build a team culture and sense of community that overcomes geographic separation across team members.  He/she will be responsible for continuous improvement of the care management process, as well as the continued growth and development of his/her team.  The Office of Mission at Boston Medical Center will be a close collaborator in the hiring, management, and culture-building efforts for the Community Wellness Advocates.  The Manager will be expected to partner closely with the leadership team in the Office of Mission.

Compensation will be salary plus incentive based on performance against managing total cost of care.

Key Functions/Responsibilities:

  • Culture Building
    • Ensure professional network and culture of support, inclusion, and development across care management team
  • Operations Management:
    • Develop, manage, and onboard Care Managers at BACO sites
    • Contribute to building a recruitment and retention strategy to attract top care management talent across Massachusetts
    • Serve as key point person interfacing with local site Administrative Directors and Medical Directors to ensure integration of care management teams into primary care practices and hospitals design integration and onboarding plans for local BACO CM teams, maintain open lines of communication with local site leaders
  • Performance Management:
    • Review performance data for overall program and individual care managers and make action plans for improvement
    • Develop policies and systems to hold CM staff accountable for individual performance
  • Quality Improvement:
    • Constantly review, assess, and adjust CM workflows to optimize CM impact on total cost of care
    • Partner with other CM Managers across BACO to recommend changes to IT system, reporting, policies, and procedures to contribute to the constant evolution of the CM process.
  • Administrative Duties:
    • Budget and performance management: maintain individual care management budget, regularly report on clinical and financial performance measures

Metrics:  Outcomes on the following metrics across assigned BACO sites:

  • Reduction in ED and inpatient visits
  • Decreased total medical expense
  • Improved patient satisfaction
  • Improved clinical outcomes
  • Improved provider satisfaction
  • Reduction in avoidable admissions

Education: Bachelors Degree

  • Experience:

  • A minimum of four years of clinical experience is required, with care management experience preferred

  • A minimum of 3 years of management experience preferred
  • Experience working in the Primary Care setting preferred

Certification or Conditions of Employment:

  • Masters’ Degree in Nursing with experience in care management preferred
  • Masters’ in Public Health, Business, or related field preferred

Competencies, Skills, and Attributes:

  • Excellent interpersonal skills and ability to work collaboratively
  • Management skills, including ability to prioritize set goals for team members
  • Excellent written and verbal communication
  • Ability to work with diverse, safety-net population
  • Skilled at coaching Care Managers in care management skills and competencies, including clinical decision-making, patient engagement, etc.
  • Creative problem solver
  • Ability to adapt to changes in healthcare delivery at local and systems level
  • Extensive knowledge of healthcare systems and community resources
  • Ability to leverage systems and resources for improved patient outcomes
  • Strong organizational and time management skills
  • Ability to analyze performance data to identify performance opportunities and adjust and innovate models of care

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