Leads ACO Ambulatory Care Coordination programs for both D-H attributed patients and external partnering providers. Working closely with Regional Medical Director and local site leadership acts as the principal manager of ACO care coordination and case management, to include analysis of cost, length of stay, utilization, and clinical quality.
Facilitates collaboration between ambulatory, inpatient and post-acute care coordination services between D-H and external organizations.
Manages day-to-day operations and activities related to ACO ambulatory care coordination. Including appropriate staffing levels and site coverage.
Manages standard workflows and procedures for ambulatory care coordination as well as measurement and reporting of care coordination outcomes.
Manages workload data and works collaboratively with staff to make informed decisions to achieve equitable workload distribution.
Organizes and leads ambulatory care coordination learning collaborative for D-H care coordinators and external partners. Organizes and provides educational programs for care coordination staff, local sites and external partners as needed to support and enhance ACO performance.
Leads projects around continuous improvement of ACO care coordination.
Participates in departmental leadership meetings and on-going evaluation of the quality and scope of ACO programs. Serves as a conduit for communicating strategic and operational information between staff and administration.
Measures and monitors systems, processes and care coordination trends. Continuously informs the department director of performance and appropriately escalates performance variances, system barriers, and/or developments including all areas of practice, including clinical, psychological, social and environmental.
Works efficiently and effectively with external reviewing and paying agencies including Medicaid and Medicare, third party payers and community agencies as needed to facilitate care coordination.
Provides consultation to staff on cases involving difficult care coordination or practice issues.
Manages the selection of care coordination staff. Coordinates orientation of new staff. Facilitates completion of annual performance appraisals for assigned staff and takes action to address performance deficits. Maintains a peer-to-peer coaching and feedback system.
Performs other duties as required or assigned.
Master's degree (or matriculated into a master's degree program)
3 years of experience working with payer quality improvement programs required.
5 years of management/leadership experience required.
Care management experience required.
Demonstrated experience in managing multidisciplinary clinical programs in both hospital and community-based health and social service delivery systems.
Strong leadership, written and verbal communication, and computer skills.
Demonstrated application of quality management and improvement.