The ConcertoCare Population Outcomes Manager is a key member of the team, focused on improving patient care quality and reducing avoidable utilization. They collaborate with clinical and operational leaders to develop strategies that minimize hospitalizations and medical expenses. Reporting to the Senior Director of Medical Expense Performance, they analyze data to drive change initiatives and lead through informal and matrixed leadership models.
ESSENTIAL DUTIES AND RESPONSIBILITIES
- Identify and analyze impactable utilization trends, and partner with the market interdisciplinary team to identify and plan interventions:
- Using Root Cause Analysis and other clinical assessment strategies, analyze inpatient admissions to identify preventable utilization, and build strategies to avoid future utilization within the market’s membership.
- 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
- Actively screen entire market population utilizing integrated data to identify patients at increased risk for utilization
- Utilize internal and external reporting tools and data to guide opportunities to reduce hospitalization and rehospitalization in collaboration with all market-level leadership
- Design, implement, and manage projects in partnership with the Director of Clinical Care, Market Medical Director, 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
- Assist with data summary and analysis presentation for use in JOC meetings
- Support proof point analyses by providing clinical expertise and insights
- Lead and support medical expense management activities including data review, audits, and reporting
QUALIFICATIONS
- Current multistate RN License in good standing
- Must be located in the Eastern Standard or Central Standard time zone
- Bachelor’s degree or equivalent years of related work experience. Master’s degree preferred
- Four or more years of clinical experience, including at least 2 years in a value-based care environment
- Geriatric care experience
- Population health experience highly desired
- Knowledge of Medicare and Medicaid highly desired
- Team leadership experience, particularly with indirect authority or in matrixed organization
- Must have experience and be highly competent in report generation and data analysis in excel
- Experience performing root cause analysis highly preferred
- Demonstrated skills/ experience in Program Implementation and Project Management/or
- Highly professional interpersonal skills, with ability to communicate effectively in writing and verbally
- Demonstrated ability to perform multiple concurrent tasks with minimal supervision and meet deadlines
- Ability to work in a fast paced, dynamic environment and work well with others on a team
- Requires strong technological capacity, including advanced knowledge of Microsoft Office, including excel and word, familiarity with SharePoint, and frequently used mobile device applications.
Base Salary/ Wage Range $85,000 to $95,000 plus annual bonus. Compensation for the role is commensurate with the candidate’s qualifications, skills, competencies, and experience 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
