Director of Clinical Operations

Job Description

We are a groundbreaking team of healthcare professionals focused on making a major impact in healthcare. We align every aspect of our health plans to support patients seeing our providers; we drive health improvements, create a seamless member experience, and eliminate duplicative costs. We listen to the needs of our patients and our employees, continually working to push beyond the status quo in which the care system manages patients today. For us, it’s all in a day’s work. Descripion: The Director of Nursing and Clinical Operations is a key strategic leadership role that provides design, development, implementation, integration, and oversight responsibilities for the health services function in a region. The role is accountable for clinical program development, integration, ensuring contractual compliance and success, and achievement of ACO Reach clinical, quality, utilization, and patient satisfaction goals. DNCO is responsible for developing the capabilities and refining the strategies required to effectively launch, grow, and manage the products within Health Service clinical programs, vendor relationships, and technology enabled health solutions. They balance the needs of our business and ensure that solutions identified are both valuable and viable. The DNCO partners closely with the General Manager, Regional Chief Medical Officer, Behavioral Health, and Medical specialists while overseeing an interdisciplinary care team that includes but is not limited to: Nurse Care Managers, Social Workers, Care Coordinators, Health Coaches, Transition of Care Coordinators, and Dietitian. To ensure success the DNCO works closely with key internal partners including but not limited to Business Development, Medical Management, Operations, Education, Implementation, and Human Resources. This role develops partnerships with primary care practices, joint venture partners (i.e., Independent Physician Associations), vendors, community-based resources (i.e., meals on wheels, transportation companies), and healthcare systems (i.e., Hospitals, Home Health, Skilled Nursing Facilities (SNF), Hospice, Behavioral Health (BH), Health Homes) to ensure the development and integration of innovative and comprehensive programming to improve patient care and outcomes. Primary responsibilities for this role: Build and maintain relationships with joint venture partners, health plans, collaborative partners, vendors, Health Information Exchanges (HIE’s), healthcare systems, and community-based organizations Staff oversite: hire, mentor, and support staff for professional growth and learning opportunities, complete performance reviews, identify individual staff goals Ensure strong case management program Use data to drive strategic decision making and planning Develop and monitor clinical and business dashboards/metrics that drive patient outcomes and key performance metrics Works closely with staff education and onboarding personnel to ensure education and training continues to meet evolving staff needs. Identify staff needs and determine resources to further enhance knowledge and professional growth Assist in the development of field guidebooks that create consistency in practice and protocols and enhance on the job learning for team members Collaborate to develop innovative solutions, programs, and pilots to overcome healthcare barriers Write Health Services policy and protocols and review/revise annually Develop Health Services job descripions and collaborate with recruiters on staff hiring Assist in the development and implement disease state management and evidence-based practices that are interdisciplinary in approach and design Understand NCQA, STAR, HEDIS, CAHPS measures and standards and participate in development of action plans to meet goals Coordinate the management of Complaints and Grievances, ensuring required response timeframes are met Collaborate on processes to manage internal and external referrals for healthcare service (i.e., BH referral, Home Health) and specialists (i.e., cardiology, pulmonology). Monitoring for necessity, cost, and outcomes Oversee the development and maintenance of community-based resource manuals Incorporate principals of Utilization Management into practice to ensure healthcare services are delivered timely, for the right length of time, achieving high quality outcomes Manage Direct Admit to SNF process by ensuring appropriate criteria and medical documentation submitted to accepting agency. Work in collaboration with medical team, offices, medical records Understand and review State, Federal, CMS Regulations that pertain to business development, partners, and practice Qualifications: MPH, MHSA, MBA, or related graduate degree BSN, other 4-year clinical degree will be considered 7+ years of progressive experience in healthcare management, operations, and program development 3+ years of hospital clinical experience, plus home care, health plan, or hospice experience Expertise in Case Management, Utilization Management, Performance Improvement Experience using analytics, metrics, and user feedback to drive strategy and execution Ability to develop and implement clinical programs with clear demonstration of results Understanding and experience with clinical service products (i.e., disease management, wellness programs, etc.) or provider network management services or offerings Experience developing and implementing innovative clinical programs Strong knowledge of HEDIS measures, quality gap management, STAR ratings Full understanding of Patient Satisfaction, CAHPS reporting and experience developing improvement strategies Experience growing business by understanding customer insights and competitive intelligence Solid computer skills including Microsoft Office programs (Excel, Power Point) and Visio Preferred Qualifications: Experience in interdisciplinary team management Experience acquiring and analyzing data using appropriate standard quantitative methods across a spectrum of business environments to facilitate process analysis and improvements How You are Supported: You will benefit from our company’s exceptional total rewards package, including competitive base pay with bonuses, unlimited paid time off for this role, 12 paid holidays per year, reimbursement for continuing medical education, 401k with 4% match, health, dental, and vision insurance. Family friendly policies that support paid parental leave and flexible work arrangements. As a team member you’ll be supported by our robust commitment to training and development that starts with onboarding and continues throughout your career with us. You will collaborate with like-minded healthcare professionals who, like you, understand the importance and value of our high-quality, value-based, care model.

Type: Full-time
Pay: $80,000.00 to $100,000.00 per YEAR

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