POSITION SUMMARY:
The Senior Director Complex Care Management oversees the Complex Care Management program strategy, implementation and staff across the Boston Medical Center Health System's (BMCHS) Medicaid Accountable Care Organizations (ACO), which are partnerships between the WellSense health plan and eight provider systems across Massachusetts including the Greater Boston, Southeast MA, South Shore, North Shore, Lowell, and Springfield/Holyoke areas. The Complex Care Management program includes direct delivery of field-based care management across the ACOsā hospitals, primary care clinics, and community health centers, as well as partnership and management of delegated care management arrangements within the network. Ā
In close partnership with other leaders within Population Health Services, the Sr. Director will be responsible for setting a strategic vision for Complex Care Management as a key part of the larger BMCHS care management continuum, and overseeing operations and outcomes of the program. He/she will develop and maintain oversight of outcomes and performance data, be responsible for adjusting program design and implementation to achieve program goals, and be accountable for helping to drive quality outcomes. Additionally, the Sr. Director will continue to innovate and build programs and collaborations that enhance BMCHS's complex care management programs by leading efforts to develop targeted initiatives that impact the highest cost patients, such as a homelessness programs, clinical specialty programs (i.e. End Stage Renal Disease, Sickle-Cell Disease, palliative care), and other community collaborations that strengthen connections across the continuum of care. The Sr. Director serves as the primary subject matter expert and technical liaison for health system partners and leaders related to the development and delivery of care management programs. The Sr. Director is also a key representative to EOHHS and governmental leaders in advocacy of care management.
Position: Senior Director, Complex CareĀ Ā Ā Ā Ā Ā Ā
Department: Pop-Health Care Management
Schedule: Full Time
ESSENTIAL RESPONSIBILITIES / DUTIES:
The Sr. Director will have the key responsibility for recruitment and retention of high-performing care management teams and will play a mission critical leadership role in interfacing with system leaders to support ACO retention andoptimizeintegration of care management teams into Population Health strategy.
Leadership within BMCHS:
In partnership with health plan and hospital leaders, iterate the strategy of the Complex Care Management program to support system goal and population needs, and to ensure ongoing close coordination between care management programs
Develop and nurture constructive partnerships with leaders across BMCHS, includingWellsenseHealth Plan, Boston Medical Center, the Faculty Practice Foundation, and leaders of joint venture ACO partners across Massachusetts; collaborate with provider leaders to iterate program adaptation to local practice and ACO needs as appropriate
Represent BMCHS in care management related discussions with state and representative bodies
Care Management Program Management
Define key program elements for care management programs,including:patient selection criteria, care management workflows and processes, team role composition, staffing ratios, etc.Ā
Centrally manage and implement a standardized care management program meeting state regulations and quality standards, while understanding the nuances of local clinical site dynamics and partnering with local site leaders and existing local site programs to ensure program success
Define methods for measuring program success anddemonstratingprogram effectiveness in managing total cost of care; partner with Clinical Analytics leads to define data and reports needed to manage performance
Contribute to the field of Complex Care through participation,leadershipand advocacy in national forums andinterorganizationalpartnerships
Care Management team leadership:
Hire, develop, and motivate Care Management Directors and Managers
Define recruitment and retention strategy to attract top care management talent across Massachusetts
Serve as key point personinterfacing withACO partner CM/PopHealthleadership to ensure integration of care management teams into primary care practices and hospitals
Maintain open lines of communication with local site leaders
In partnership with the CCM medical director and other CCM leaders, ensure the maintenance of a robust training and education curriculum for care management staff, and oversee a professional development strategy for staff across disciplines
Metrics:
Design programs and interventions targeted at key program outcomes, including:
Reduction in ED and avoidable inpatient visits
Decreased total medical expense
Improved patient satisfaction
Improved clinical outcomes
Improved provider satisfaction
Performance on contractual audits with state and regulatory agencies
Other Duties
Perform other duties as needed.
JOB REQUIREMENTS
EDUCATION
RN or LICSW licensure preferred; other clinical specialties may be considered
Bachelorās degreerequired
Masterās degree in ahealth relatedfieldĀ
CERTIFICATES, LICENSES AND CERTIFICATION
Licensure:
Social work candidates must be independently licensed
Nurse candidates mustmaintainRN or NP licensureĀ
Certification
Preferred qualifications:
Demonstrated interest inservinga culturally and socio-economically diverse patient population, particularly those with complex medical and behavioral health conditions including chronic medical illness, serious mental illness, and substance use disorder.
EXPERIENCE
Significant experiencein clinical operations in a hospital, health system, provider practice, and/or community health center environmentrequired
Experience leading complex care management programs
Experience building and managing a large, field-based team
10+ years of healthcare experience, with 5-7 years of leadership experience, including leadership of managers or directors
KNOWLEDGE, SKILLS AND ABILITIE
bmc