Director Population Health Hfhp - Member Outpatient Services

POSITION SUMMARY

Accountable and responsible for collaboratively leading, integrating and continuously evolving the care management programs and activities for Health First Health Plans in partnership with appropriate senior leaders. Develop and maintain care management strategic plans to support population health goals and initiatives to meet member needs across the continuum of care, including Integrated Care Program clinics. These needs will range from wellness and preventative health to end-of-life planning and everything in between. Lead and implement evidenced-based standardization of best practices throughout the programs. Develop a coordinated approach to care management across the continuum by partnering with physicians, community base, and post-acute care providers.

PRIMARY ACCOUNTABILITIES

• Provide leadership, motivation, coaching, feedback, and support to foster and strengthen growth and development of an effective, high-performing team.

• Demonstrate leadership and industry expertise by collaboration and communication with other health plans, hospital constituents, Health First departments, hospital facilities, physicians, and other community health service providers to ensure patient/member obtains the best quality care available.

• Develop policies, procedures, and standards for the department and ensure these are reviewed and revised annually or as needed.

• Assess areas of greatest opportunity within the markets and target specific optimal efficiencies through evidence-based protocols and innovative care management strategies.

• Drive the development and practice implementation of population health initiatives and integrated care programs, and continue optimizing as needed to achieve the desired clinical and business outcomes.

• Ensure the Care Management team at the Health Plans is compliant with all regulatory and accreditation agency standards. Prepare for site visits and respond to accrediting and regulatory agency inquiries and audit requests including CMS, Medicare Stars, NCQA, and any other regulatory requirements.

• Facilitate Case Management involvement in establishing, implementing, coordinating, modifying, and optimizing a collaborative, appropriate and member/patient centric plan of care while ensuring clinical, customer/patient satisfaction and achieving financial goals.

• Develop innovative methods of directing and measuring department operations, utilizing data, technologies, and maintaining efficiency of process and staff productivity.

• Provide oversight and guidance with Case Management departmental operations to include KPI's for productivity measure, outcomes measures, budget preparation, operations monitoring, assignment scheduling, quality improvement initiatives and departmental audits.

• Produce and analyze reports for medical cost trends, dashboards, quality initiatives and identify areas for improvement.

• Stay at the forefront of value-based care to gain new ideas and best practice strategies for continuous performance improvement

LEADERSHIP ACCOUNTABILITIES

• Define and communicate a clear, compelling vision for the team that effectively ties into the mission and vision of Health First, and inspirationally leads the team to achieve that vision.

• Provide leadership, motivation, coaching, feedback and support to strengthen growth, development and wellness at work to build and foster effective, high-performing teams.

• Lead change through effective communication, explaining the connection and value to the organization, creating stronger buy-in and urgency, while understanding impact to the team to obtain commitment.

• Demonstrate openness to hearing diverse ideas and thoughts; create a sense of inclusivity; and encourage collaboration across teams to help break down silos to meet the team's and organization's goals.

• Recruit, select, grow, and retain highly engaged, high-performing diverse and inclusive associates.

• Display strong strategic and financial acumen in areas of responsibility in alignment with the organization's strategic objectives.

MINIMUM QUALIFICATIONS

Education: Bachelor's degree

Licensure: Current Florida RN/Clinical license or MSW

Certification: None required

Work Experience:

• 5 years of combination of hospital based clinical nursing experience, case management, Utilization management and Quality Management/Managed care experience.
• 3 years' progressive administrative experience leading care management or population health programs.

Work Experience in lieu of Education: None

Knowledge/Skills/Abilities:

• Knowledge of CPT Codes, HIPAA, ICD-9/ICD-10 Codes, Medicare/Medicaid Guidelines, Joint Commission, and other regulatory/accreditation agencies.

• Knowledge of Coordination of Benefits where applicable. (i.e., Worker's Compensation, Auto Insurance-, Short- and Long-Term Disability).

• Knowledge of Billing and Claims Processing.

• Knowledge of alternative treatment options, alternative funding programs and community services and resources.

• Demonstrated skills in leading and facilitating work efforts.

• Strong analytical, communication and problem-solving skills.

• Ability to conduct meetings and speak in front of large groups.

• Ability to utilize personal computer and desk top applications: Word, CMS, McKesson lnter

Qual criteria, Midas, Microsoft Office, power point.

• Effective time management skills.

• Excellent oral and written communication skills.

PREFERRED QUALIFICATIONS

Education: No additional

Licensure: No additional

Certification: Certification in Case Management (CCM).

Work Experience: No additional

Knowledge/Skills/Abilities: No additional

PHYSICAL REQUIREMENTS

• Majority of time involves sitting or standing; occasional walking, bending, stooping.

• Long periods of computer time or at workstation.

• Light work that may include lifting or moving objects up to 20 pounds with or without assistance.

• May be exposed to inside environments with varied temperatures, air quality, lighting and/or low to moderate noise.

• Communicating with others to exchange information.

• Visual acuity and hand-eye coordination to perform tasks.

• Workspace may vary from open to confined; on site or remote.

• May require travel to various facilities within and beyond county perimeter; may require use of personal vehicle.