The Regional Manager, Accountable Care Organization (ACO) Clinical Programs is primarily responsible for day to day operations of an integrated multi-disciplinary clinical and clinical support structure that will effectively monitor, support and lead ACO clinical initiatives. This includes discharge planning, case management, coordination of care, provider education on ACO clinical programs and helping to build and maintains a network of community support. This individual must exhibit the necessary leadership and management skills as well as the ability to utilize both internal and external resources to accomplish the goals and objectives of the organization.
Monitors corporate initiatives and strategies to achieve utilization of business and financial goals.
Manages the successful integration of ACO programs into current operations to meet the goals of all stakeholders.
Maintains collaborative relationships with business partners both within the company and the community.
Manages and execute organizational opportunities and implement changes that are in alignment with corporate financial goals and strategic endeavors.
Effectively manage day to day CCM and ACO clinical programs to enhance clinical efficiencies
Identifies opportunities for increased outpatient vs. inpatient utilization.
Manages the inpatient activities which include but are not limited to:Daily on-site and or telephonic discharge planning as needed.
Transitional care management
Post discharge follow up for medication reconciliation, DME and home health services, specialist and or comprehensive clinical appointments and community resources/social services.
Executes case management program for high utilizers, non-compliant beneficiaries, multiple chronic diagnoses beneficiaries to reduce hospitalization
Monitors the established standards and programs to ensure effective follow-up of CCM and CO ACO Emergency Room encounters.
Implements and directs ACO Health Education Activities for beneficiaries, providers and staff.
Utilize data provided to help in managing population health needs and implements population programs for ACO beneficiaries.
Participates in Care Coordination and Quality Committees, Primary Care Provider Office Meetings and hospital Joint Operation Meetings.
Bachelors in Nursing/ Registered Nurse licensure required
2 or more years of experience in clinical operations within managed care environment
Clinical knowledge with Medicaid/Medicare populations
2 or more years of experience leading staff, including some direct reporting responsibilities; field based staff is a plus
Ability to communicate effectively and demonstration in identifying problems and effectively relay insights to facilitate corrections and improvements
Demonstrated track record of clinical program compliance
Strong ability to lead by influence and develop/mentor staff
Adept in cross functional interactions and collaboration and meeting program goals
Demonstrated track record of leading and developing people
Intermediate computer skills in: MS Office Suite- PowerPoint, Excel, Word
Masters in Nursing, Business or Healthcare Administration
Field based case management program implementation and monitoring
Millennium Physician Group