- 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 staff from the complex case management, health coaching, physical and behavioral condition management teams.
- Responsible for communicating policies and procedures that integrate the work of all positions within the care management organization, 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 Director of clinical operations to optimize the performance of his/her clinical team.
- 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 client clinical staff, community physicians, Evolent Health Chief Medical Officer, Pharmacy Director, and senior management team. Ensures incorporation of necessary customization and local variation to achieve buy-in.
- 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.
- Partners with account management staff to insure our client organizations are establishing incentives, systems and processes to engage our client’s employees in better accountability for their health.
- Serves as a change agent for and advisor to local health system staff, physicians, 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.
- 8-10 years of clinical staff management experience in a population management or managed care/insurance or hospital case management department setting
- Current Registered Nurse license
- Minimum of 4 years of operational management experience in a clinical setting
- 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.
- 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.