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The Director, Clinical Care Partnership is responsible for the leadership, management and oversight of five to seven multi-level teams comprised of Clinical Managers and their direct reports. The Director, Clinical Care Partnership provides guidance to the clinical managers and is accountable for the outcomes of interdisciplinary Care Teams, which, in their totality, make up the CCA clinical enterprise spanning across the Commonwealth of Massachusetts. The Clinical Enterprise is accountable for the care management, care coordination, and provision of enhanced primary care to a majority of CCA’s SCO and One Care membership. This position reports into the Vice President of Clinical Services.
Provide leadership, individually and through multilevel direct reports to meet the clinical and health plan metrics, initiatives and activities set by CCA Clinical Leadership all while remaining aligned with CCA’s mission and values. Follow through/follow up, respond to the data/metrics associated with the work of the teams, provide guidance and leadership to meet organizational goals. Responsible for the ongoing operations of the teams.
Accountable for KPI’s associated with the Clinical Enterprise including lead and lag measures such as admission/readmission rates, total medical expenditure, MDS timeliness, HCC scoring accuracy, closing of HEDIS quality gaps, ACA completion, and activities associated with the timely decisions of prior authorization service requests.
Accountable for the KPI’s associated with CCA’s Care Delivery, ensuring that the care provided directly by CCA clinicians is of the highest quality and appropriate for the individual needs of the member. KPI’s include medication adherence, evidence of positive management of chronic disease, evidence of management of urgent needs, and Advanced Care Planning.
Accountable for KPI’s associated with member experience: including timely engagement between newly enrolled members and their care partners, standardized frequency of visits, appropriate utilization of CCA’s internal clinical services to decrease acute care utilization.
Promotes behavioral health integration within the teams by maintaining close collaboration with BH leadership.
Engage as needed with cross-functional leaders and external stakeholders including partnering PCP’s, ASAPs, and Independent Living Centers to enhance communication and relationships across the organization.
Acts as a liaison and maintains good working relationships with external collateral providers such as ASAP’s, HSP’s, primary care sites, state agencies, and hospital systems.
Makes recommendations to leadership on approaches to enhance the effectiveness of clinical practice and programs.
Leads team strategy and planning meetings, conferences, and organization wide meetings.
Participates in budget development by forecasting staffing needs, defining space and operational requirements. Manages the monthly budgets for the clinical group, including evaluating variances and creating action plans to prevent further variances.
Responsible for reviewing and distributing cost and utilization data across teams, as appropriate. Transitions data and expectations to direct reports and ensure follow through.
Investigates, documents and reports on complaints.
Works with HR and other managers to hire, retain, and recruit for positions as needed.
Direct supervision including performance reviews for direct reports. Manages performance tracking system to ensure performance reviews are up to date and improvement systems are in place, where needed.
Be an available resource to support the clinical team/s and conduct home visits, as needed.
Identify and foster career development and advancement opportunities for members within the team.
Coaches, mentors and trains new and existing team members in political, organizational, industry/business, behavioral and technical skills.
Minimum Master’s degree or equivalent experience.
Masters level or advanced practice degree highly desired.
Licensed to practice in an advanced role with 5-7 years of progressive relevant clinical based administrative management experience in a healthcare environment.
Proven skills, knowledge base, and judgement necessary for independent clinical decision making in alignment with clinical.
Excellent organizational, time management, and problem solving.
ID: 2019-2432 External Company Name: Commonwealth Care Alliance, Inc. External Company URL: http://www.commonwealthcarealliance.org/ Street: 101 Wason Avenue, 3rd floor Telecommute: No
