Summary: Clinical Lead for WellSpark that delivers a transformative model of chronic condition self-management focused on lifestyle and behavioral changes with patients/ members in support of a client strategy to control long term healthcare costs. Using a patient centered approach, nurses will engage members who have been identified as at-risk and coach and educate members on improving the management of that condition through medication adherence, lifestyle changes and improvements in health literacy. This position is both internal and externally facing with success being achieved through collaboration with employers, physician ACOs, behavioral health providers and other care management vendors. This role is responsible for overseeing existing clinical programs and creating new models of care to achieve high levels of engagement with meaningful clinical and psychosocial results for WellSpark participants with chronic diseases.
- Creates and manages dynamic team(s) of clinical staff who deliver wholistic self-management education and skills to participants with a pre-disease or chronic disease, with a goal to improve disease onset and progression.
- Subject matter expert on understanding total population health and the ability to identify and meet the biopsychosocial needs of the population that are often currently not addressed within traditional care management programs.
- Establishes effective workflow standards across clinical teams to align and ensure standards of care protocols are delivered, systematically tracked and recorded to serve as process monitoring controls and indicators for critical performances.
- Establishes Key Performance Indicators (KPIs) for program impact studies and implements process monitoring controls to measure outcomes.
- Responsible for staff maintaining and achieving compliance with national standards of care and recognized certifications such as ADCES, CDC, AHA as well as any other regulatory requirements.
- As applicable, works in collaboration with community-based providers, ACO’s and health plans to identify, align and implement integrated care coordination and total population health strategies that maximize all available skills and resources to improve participants health status, improve quality outcomes and reduce current and future medical costs.
- Provides direction, leadership, evaluation and development of staff. Ensures that a high performing work culture is embedded within the departments.
- Identifies, obtains, and processes critical data (e.g., benchmarks) to challenge the status quo through innovative thought leadership. Work cross functionally to identify areas of analysis for impact studies and outcome leading to national recognition through our published results.
- Works with our external technology and clinical partner(s) to integrate and adapt or build tools into our programs, ensuring value to the participant and proof points, such as engagement and ROI to WellSpark’s customers.
- Works directly with CMO and other VPs to drive the strategic direction and innovation plan to improve the holistic, total population wellbeing experience for medical, behavioral health management, and quality/wellness programs including but not limited to preventive screening and care, lifestyle health coaching and case and disease management.
- Collaborates with others to establish transformative and innovative care and utilization management processes.
- Works in close partnership with full leadership team across operations and account management to create consistent seamless and holistic workflows, processes, and reporting for all external customers including but not limited to the State of CT and the City of New York.
- Contributes to the sales process as a Subject Matter Expert (SME) for client/ prospect meetings and Request for Proposal (RFP) responses.
- Provides clinical and workflow management oversight direction for design, development, testing, and implementation of software applications used to support Total Population Health.
- Drives to raise the bar in outcomes by partnering and developing the skills and medical management capabilities of physician organizations and partnerships. Cultivates cooperative relationships with their respective organizations through partnerships with critical clinical business partners, designed to improve the quality and cost-effectiveness of care delivered to members.
- Participates in the expansion of WellSpark on a national basis with thought leadership and clinical expertise on engagement and technology tools to support health improvement.
- Performs other related projects and duties as assigned.
- RN, licensed in Connecticut. Bachelor’s Degree in Nursing or an equivalent combination of education and experience preferred.
- At least ten years of clinical and chronic disease management experience.
- Demonstrated success in achieving and sustaining high levels of NCQA accreditation in Managed Care and Disease Management and health coaching is preferred.
- Accountable Care Organization experience preferred.
- At least five years of demonstrated successful managerial experience with the ability to work in a matrix management environment.
- Experience collaborating with IPA, PHO, and/or group practice models related to medical utilization, and/or resource management and quality assurance.
- Prior experience working with Medicare and Medicaid preferred.
- Proven ability to quickly change gears in a fast-moving environment.
- Demonstrate knowledge and exposure to behavioral health/social work fields/practices.
- Computer literacy (Microsoft Word, Excel, PowerPoint, and Access) desirable as it relates to the ability to manipulate and analyze data.