What You’ll Be Doing
Reporting to the Client’s Chief Operating Officer, The Senior Director, Clinical Operations a key member of the Clinical Operations Team and plays a critical role in our growth as one of the senior leaders responsible for working with clients to realize targeted engagement, clinical and economic outcomes. Specifically, this individual will oversee the implementation of ongoing management of the client’s tailored population health model.
Specific responsibilities of this role include participating in developing and driving an annual clinical initiative plan, monitoring key program and population metrics, participating in quality improvement efforts and working directly with the care management staff including RN care managers, PCPs, community health workers, health coaches, behavioral health specialists, social workers, and pharmacists, in delivering optimal results.
In addition, this individual will contribute to the ongoing development of clinical guidelines and protocols used in delivery of population health services, as well as the ongoing design and commercialization of the company’s integrated population analytics and care management workflow technology platform.
Finally, the Senior Director of Clinical Operations will prove central to building and strengthening the business case that proves Evolent Health’s model; that is, directing a comprehensive, client tailored program that improves quality, outcomes and population health while simultaneously lowering costs and annual trend for the populations served by partner health systems. Serves as a member of the client’s leadership team and participates in the organization’s strategic and day-to-day activities.
- Oversees the development and ongoing operation of the Evolent Health Care Management Services for our clients.
- Responsible for directing and overseeing the overall client population health program performance and annual clinical initiative plan to drive expected/targeted client clinical, financial patient experience outcomes. Communicates results through appropriate channels.
- Hires, trains and directs all staff who are hired directly, or indirectly to support the Model the Care..
- Responsible for communicating policies and procedures that integrate the work of all positions within the Model of Care, and ensures that they are known and followed.
- Responsible for managing the embedded/local Evolent clinical team on a day to day basis, or if the client owns the clinical staff, working/supporting/coaching the Client’s designated managers to optimize the performance of his/her clinical team.
- Serves as the leader for managing delegated agreements. Monitors performance and delegated sites; raises performance concerns as they appear; works with client and Evolent to address any performance concerns; continues to escalate performance concerns until a corrective course results in improvement.
- Employs disciplined project management process to ensure the successful implementation of client care management programs
- Masters the company’s population analytics, stratification and workflow technology platform and imparts this knowledge to the care management organization, ensuring that staff follows the policies and processes embedded therein.
- Drives the implementation of our clinical programs and quality management structure in collaboration with Partner and Evolent leadership. Ensures incorporation of necessary customization and local variation to optimize local engagement.
- Responsible for coordinating and leveraging central Evolent population health, analytics and performance improvement resources to continually improve the performance of the client’s clinical operation.
- Responsible for interfacing and communicating with the client regarding population health program performance, progress on implementing clinical initiatives and works with client to remove barriers to optimize performance.
- Serves as a change agent for and advisor to local health center staff, providers, nurses and other clinical staff to assist them on their conversion to value-based care.
- Maintains strong relationships with local health system partners, building credibility with hospital and physician leadership and with the provider community in the local market.
The Experience You Need:
- 8-10 years of clinical staff management experience in a population management or managed care/insurance or hospital case management department setting
- Minimum of 4 years of operational management experience in a clinical setting
- Working knowledge of Federally Qualified Health Centers
- Demonstrated experience with EHRs and/or Population Health Systems
- Experience in working for mission-driven organizations
- Working knowledge of ACOs and value-based health care
- Sophisticated knowledge of clinical operations in managed care, including quality management, outcomes, provider network, claims, financial management, care management policies, disease state and population management, members’ rights and responsibilities, and ability to quickly assess client practices.
- Current Registered Nurse license
- Experience in consulting or services organizations with a proven ability to manage client relationships and achieve change within another organization.
- Desire for and capability to drive toward and achieve a high standard of quality and results
- Working knowledge of clinical quality metrics such as HEDIS, NCQA or National Quality Forum type metrics.
- Entrepreneurial mindset geared toward the creation, execution and continuous improvement of a new care management model from the ground up.
- Ability to work in a fast paced, team environment with sensitivity toward client needs and critical deadlines.
- Intellectual curiosity and an ability to view old problems with a fresh perspective.
- Ability to understand the workflow of the multiple components of the company and client, and to assist in the creation and implementation of integrated policies, procedures, work plans and creative solutions.
- Experience in project management and process improvement.
- Experience in data analytics (preferably population analytics), and use thereof to target opportunities.
- Ability to attract, manage and develop staff of superlative quality
- Excellent written, computer, and oral communication skills.