Director, Care Management Operations
Less than 5 years experience • IT Consulting/Services
ConcertoHealth Inc. is the leading provider of specialized primary care and supporting clinical services for complex, frail, elderly, and dual-eligible patients. Operating exclusively in value-based agreements, ConcertoHealth provides high-touch, individualized care for patients, and deploys wraparound clinical resources to extend the reach of primary care practices. This comprehensive medical management solution, elevated by Concerto’s proprietary population health technology, improves overall healthcare quality and patient outcomes, benefitting payers and their provider networks. The company is headquartered in Irvine, Ca. For more information, please visit www.concertohealth.com.
The Director, Care Management Operations reports to the VP, Clincial Operations and is a regional position that will support and guide regional care management functions in a fast paced, growth oriented population health organization. This dynamic role will support and manage a team to drive exceptional patient outcomes for a complex patient population using innovative technology solutions in a multidisciplinary care setting. This role will be accountable to achieve exceptional service and meet contract commitments to health plan partners and regulators, and drive project implementation activities and best practice policies and processes. The role will recruit and manage a range of care management professionals, including clinical and non-clinical positions, who collaborate to serve a diverse membership base.
This seasoned leader will monitor performance quality and performance metrics while also providing recommendations on operational design and efficiencies. The position will also collaborate with other stakeholders and functional areas.
Position is based in our Renton, WA office, and will need to travel at least 1 day per week to the Lynwood and Lakewood offices (each approx. 1 hour from Renton.)
- Responsible for the development and execution of care management activities to drive compliance with health plan partners’ models of care
- Develops and maintains collaborative relationships with otherinternal market leaders, payor partners, regulators and corporate teams
- Leads cross-functional clinical and non-clinical meetings and other projects
- Functions as market care management leader during implementation as needed to accommodate organic and new product growth
- Monitors care management clinical operations as well as contractual and regulatory operational requirements during implementation and post-implementation to drive compliance, quality outcomes and operational efficiencies
- Functions as care management subject matter expert, understands and maintains knowledge of delegated lines of business and community provider relationships
- Monitors staffing and budget for care management
- Supports and oversees care management acuity assignment methodology, including supporting new technology development by defining business specifications/requirements for clinical operations
- Oversees risk stratification guidelines compliance through reviews of care management activities and systems reporting
- Identifies and executes on best practices for care plan development and management
- Responsible to support achievement of cost, quality, and patient/member experience goals
- Leads the care management and social work teams ensuring they are effectively and efficiently operated, resourced and performance managed by market leadership
- Directs, plans and evaluates care management documentation quality through independent reviews and through the monitoring of the internal quality review tool(s)
- Develops care management policies, procedures or other job aides as needed
- Participates in collaborative meetings between care center staff/providers and care management across all markets, leads clinical operations oversight meetings and maintains agenda and written meeting minutes
- Develops performance improvement plans or other quality monitoring tools to support performance expectations for all staff
- Tracks and reports to supervisors and other market or corporate leadership using systems reports on a defined frequency, taking efforts to validate accuracy and completeness on a regular basis
- Participates in personnel management including recruiting, hiring, goal setting, evaluations and team building
- Promotes a positive work environment, sets an atmosphere of open communication and feedback
- Performs, at a minimum, an annual assessment of operational performance across all key success metrics
- Other duties as assigned
3-5 years Health Plan care management experiencerequired. Experience with MMP and/or DSNP programs required. Healthcare provider experiencepreferred. Ability to travel15%, mostly within the state. Ability to work in a Windows based computing environment. Strong interpersonal and critical-thinking skills.