Primary Location Rockville, Maryland
Job Number 1237310
Date posted 11/15/2023
This position has primary accountability for developing and implementing the philosophy, strategic goals, and objectives for the care management/care coordination functions across settings of care that meet clinical, financial, and regulatory requirements of the markets. Responsible for the development of a care coordination strategy for populations requiring special care. This position has the responsibility for developing and implementing a strategy to identify a risk stratification plan to identify populations with complex needs, requiring special care and the development of interdisciplinary solutions and patient case review that will provide excellent care across the continuum for these populations.
- This position is responsible for leading the market strategy, planning, and execution of a patient centered and integrated approach to care coordination and resource stewardship across the continuum of care.
- This position will provide executive leadership and oversight for the development of a comprehensive care coordination and resource stewardship strategy work throughout MAS and the following:
- Provides leadership to health plan and medical group providers in the development of regional strategies to coordinate and plan the provision of health care services across the continuum of care for patients with complex needs.
- Creates the structure and processes to identify populations with complex needs and to develop, implement and evaluate programs, policies, and standards for continuum of care services that develop coordinated plans of treatment and delivery systems to provide excellent service to those members with complex needs.
- Defines and communicates strategic objectives and scope.
- Articulates issues or problems from a broader organizational/mission perspective and escalates unresolved barriers and roadblocks.
- Champions new ways of meeting targets and/or goals. Explores critical issues not explicitly addressed by others. Anticipates and plans for future issues or problems.
- In collaboration with internal and external leaders/stakeholders develop, implement, and promote an integrated strategy and operational plan for care coordination and case management within and across hospital, post-acute and skilled nursing facility settings to improve, facilitate and streamline the care delivery process, the patient and provider experience to improve quality, cost, and experience.
- Ability to lead and manage through influence and change. Demonstrated ability to lead professionals through influence and collaboration.
- Identifies and institutes performance improvement efforts based on evidence-based research, practices, and patient outcomes.
- Understands the finances of various care settings, contributes ideas, and plans for efficient stewardship of resources appropriately.
- Facilitates the rapid transfer of best practices within the MAS Region.
- Partners with health plan and medical group leaders to ensure optimize care coordination across care setting, programs and the continuum.
- Ensure compliance with all applicable care coordination and case management regulatory and accreditation guidelines such as Medicare, DHCS/Medicaid, Department of Managed Healthcare (DMHC), The Joint Commission (TJC), and National Committee for Quality Assurance (NCQA) regulatory requirements, as appropriate.
- Actively supports MAS Executive Resource Steering Committee and co- chairs or contributes to regional/market or enterprise committees and workgroups.
- Recruits and develops high performing and highly engaged leaders, including a talent pipeline.
- Minimum eight (8) years of substantial experience progressive operational experience in clinical and leadership roles in a multi-faceted health care system and multi-provider settings.
- Bachelors degree.
- Registered Nurse License (Maryland) OR Compact License: Registered Nurse OR Registered Nurse License (Virginia) OR Registered Nurse License (District of Columbia)
- Extensive experience within the continuum, including but not limited to hospital, skilled/ post-acute, ambulatory, care coordination, and resource stewardship operations
- Strong understanding of data analytics, healthcare, population health, medical delivery, and medical management; robust understanding of industry trends and best practices.
- Demonstrated knowledge and experience with Medicare and Medicaid managed care, NCQA, TJC and other regulatory requirements
- Successful experience managing a broad range of financial and organization issues, such as organizations redesign, improving internal controls, financial turnaround, creating a performance-oriented organization and change management.
- Decisiveness, action-oriented, personal integrity, capability to persevere in difficult situations and a focus on strategic leadership issues. Candidate should also possess an open, collaborative leadership style that promotes teamwork and partnership while achieving desired results.
- Demonstrated ability to successfully plan, organize, and manage programs and projects with proven track record of effective collaboration and strong leadership and people leadership competencies.
- Ability to understand and synthesize data as it translates to care management related to programmatic implications; strategic thinker who values data and can draw the best conclusions and shape the best path forward.
- Strong and demonstrated experience with leading with best practices and proven methodologies for process improvement, scalability, and automation to support long-term growth objectives.
- Master’s degree preferred.
Primary Location: Maryland,Rockville,Rockville Regional Offices
Scheduled Weekly Hours: 40
Working Hours Start: 08:00 AM
Working Hours End: 05:00 PM
Job Schedule: Full-time
Job Type: Standard
Employee Status: Regular
Employee Group/Union Affiliation: NUE Executives|NUE|Non Union Employee
Job Level: Director/Senior Director
Department: Po/Ho Corp – Rgnl Clrng-Mid-Atlantic Hp – 0308
Pay Range: $225000 – $281250 / year
Travel: Yes, 15 % of the Time
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