JOB SUMMARY
Reporting to ConcertoCare’s Vice President of Population Health the Director, Population Outcomes functions as a key member of the ConcertoCare market clinical leadership team. The Director, Population Outcomes is directly responsible for developing and managing strategies to address utilization and other high-cost medical expenses for the assigned market(s) population through a variety of activities, and for ensuring that key components of ConcertoCare’s Care Model are being used by providers to drive population impact. The Director, Population Outcomes supports the mission, vision, and values of ConcertoCare in delivering individualized, proactive care to high-risk patients within the market practice.
The Director, Population Outcomes works in conjunction with the Population Outcomes Manager and collaborates with the Market Medical Director(s), as well as other Directors of Population Outcomes from across the organization to share best practices and develop solutions for organization wide utilization issues.
ESSENTIAL DUTIES AND RESPONSIBILITIES
- Identify and analyze impactable utilization trends, and partner with assigned market(s) interdisciplinary teams to identify and plan interventions:
- Using Root Cause Analysis and other clinical assessment strategies, analyze inpatient admissions to identify avoidable utilization and the root causes driving the avoidable utilization, and develop and implement strategies to avoid future preventable utilization within the market’s population
- Prepare case summaries to facilitate interdisciplinary discussion targeted at identification and planning of activities with the interdisciplinary team that will prevent hospitalization or worsening of patient condition
- Perform Population Surveillance on entire assigned market(s) population for early identification of rising risk patients to develop and implement plan for patient care to prevent future utilization
- Utilize internal and external reporting tools and data to guide opportunities to reduce avoidable utilization in collaboration with all market-level leadership
- Design, implement, and manage projects in partnership with the Population Outcomes Manager, Market Medical Director(s), and other key leaders to ensure interventions are being implemented, progress tracked, and outcomes reported
- Partner with actuarial and med economics team to identify trends in cost and utilization data and identify areas of potential improvement and impacts
- Compile data for use in Joint Operating Committee Meetings in partnership with Market Medical Director(s)
- Supports customer success through leading and participating in external meetings with payer case management teams, external provider partners, and community resources/ vendors Support proof point analyses by providing clinical expertise and insights
- Lead market-level SWAT huddles, including the identification of patients at risk for increased medical expense due to utilization in the next 30 days and lead discussion on interventions to decrease risk of utilization
- Manages and aggregates patient and MLR data, creates presentations for internal and external partners.?
- Lead market-level medical expense management activities and presentations to market-level and organization wide leadership, including data review, audits, and reporting
- Collaborate with market and organization leadership to execute targeted initiatives on all utilization management needs for the patients
- Articulate market utilization management annual goals and implement measures and interventions to help accomplish them in collaboration with Market Medical Director(s)
Other market-specific duties and responsibilities as assigned by the Vice President of Population Health
QUALIFICATIONS
- Graduation from an accredited nurse practitioner school
- Master’s Degree required
- Board Certified Nurse Practitioner with licenses in CA and/or WA or the ability to obtain immediate licensing.
- Active license in the worked-in-state, or the ability to obtain one
- Five or more years of clinical experience, including at least 3 years in a value-based care environment with Medical Expense or Total Cost of Care -related experience
- Geriatric care experience preferred
- Knowledge of Medicare and Medicaid highly desired
- Demonstrated ability to perform multiple concurrent tasks with minimal supervision and meet deadlines
- Team leadership experience, particularly with indirect authority or in matrixed organization
- Ability to demonstrate systems level thinking and problem solving, while maintaining focus on the individual patient level of care as indicated
- Demonstrated expertise in reporting, analyzing, and designing initiatives based on data analysis
- Requires strong technological capacity, including advanced knowledge of Microsoft Office, including Excel, PowerPoint, and Word, familiarity with SharePoint, and frequently used mobile device applications
- Demonstrated highly effective and professional verbal and written communication skills
- Ability to work in fast paced, dynamic environment and work well with others on multiple teams in assigned market(s)
Base Salary/ Wage Range $155,000 to $170,000 with annual bonus. Compensation for the role is commensurate with the candidate’s qualifications, skills, competencies, experience, and geography, and may fall outside of the range shown. ConcertoCare offers a competitive total rewards package, which includes full healthcare coverage, a 401K with match, and a broad range of other health, wellness, and financial benefits.
We are an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability or veteran status.
ConcertoCare is an Alcohol/Drug/Smoke-Free Workplace.
