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Fallon Health Director, Medicaid ACO Clinical Team - Great New Leadership Role! in Worcester, Massachusetts

Overview

ABOUT FALLON HEALTH:

Fallon Health is a mission-driven not-for-profit health care services organization based in Worcester, Massachusetts. For 45 years we have been improving health and inspiring hope in the communities we serve. Committed to caring for those who need us most, we pride ourselves on providing equitable access to coordinated, integrated care for our members with a special focus on those who qualify for Medicare and Medicaid. We also serve as a provider of care through our Program of All-Inclusive Care for the Elderly (PACE). Dedicated to delivering high quality health care, we are continually rated among the nation’s top health plans for member experience and service and clinical quality.

THE OPPORTUNITY:

It is an exciting time to join Fallon Health as we have shifted our business focus on exclusively serving members in the Medicaid and Medicare space. Central to our growth and future is our three Medicaid ACO partnerships across the state. Fallon is now in our fifth year of this program and our success has led us to creating this key new clinical leadership role. There’s a foundation and care model in place but we are looking for just the right clinical expert to help strengthen our ACO partner relationships and the clinical model, and take us to the next level. There is considerable creative opportunity for the new ACO Clinical Director to partner with our ACO clinical leaders to innovate and make their own mark in this visible and rewarding role.

POSITION SUMMARY:

The Director, ACO Clinical Services oversees the ACO Care Management program implementation and staff supporting 3 Accountable Care Organizations (ACO) across Massachusetts including Greater Boston, Southeast MA, Central MA and the Berkshires.

In close partnership with the ACO Medical Director, the VP of Clinical Integration, and the Sr. Director of Behavioral Health and Clinical Services, the Director will be responsible for setting a strategic vision for ACO Care Management and overseeing day-to-day operations of the program. You will maintain close monitoring 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 Director will continue to innovate and build programs and collaborations that enhance the ACO care management programs by leading efforts to develop targeted programs that impact the highest cost patients with a specific focus on Behavioral Health, Social Determinants of Health, and Health Equity while strengthening relationships with ACO partners and developing community partnerships across the continuum of care.

Responsibilities

The Director will have the key responsibility for recruitment and retention of high-performing care management team and provide clinical leadership interfacing with ACO partners to optimize the integration of care management teams into primary care practices.

PRIMARY JOB RESPONSIBILITIES:

  • Centrally manage and implement a standardized care management program, but also understand the nuances of each ACO partner and work collaboratively with local care teams and site leaders to ensure program success

  • Manage a multi-location ACO clinical team to ensure timely coordination of quality healthcare and care coordination services for Fallon Health members with varying levels of conditions while meeting requirements of Mass Health contract.

  • Define recruitment and retention strategy to attract top care management talent across Massachusetts

  • Maximizes the efficiency of the documentation system to ensure effective reporting of team and partner care management actions collaborating cross functionally with Fallon business partners including IT, Medical Economics and Clinical Integration leads.

  • Work collaboratively with the Medical Directors, Product Line Executive Directors, Operations Leadership, and other Fallon Health staff to ensure the implementation, modification and enhancement of workflows and operations to meet changing member benefits and criteria.

  • Develops and implements quality improvement projects and strategies to support the Program in meeting quality and performance measures including, but not limited to, NCQA, HEDIS, State, External Quality Review projects, etc.

  • Define methods for measuring program success and demonstrating program effectiveness in managing total cost of care; partner with Clinical Analytics leads to define data and reports needed to manage performance

  • Collaborate with leadership to design programs and interventions targeted at key program outcomes, including reduction in ED and avoidable inpatient visits, decrease total medical expense, improve patient/provider satisfaction, and improve clinical outcomes

Qualifications

QUALIFICATIONS:

  • Education - RN or LIC SW/LMHC

  • Extensive experience within an alternative payment and care delivery system, such as an Accountable Care Organization (ACO), Population or hospital, health system, provider practice and/or community health center required.

  • Experience building and leading complex care management programs

  • Experience managing a large care management team

  • 10 years of healthcare experience, with 3-5 years of leadership experience

  • Experience working as a member of an interdisciplinary professional team, developing care management programs that address social determinants of health, and leading data-driven, performance improvement projects.

  • Experience with state licensure, regulatory requirements as well as NCQA accreditation.

Fallon Health provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.

Fallon Health Vaccination Requirements:

To protect the health and safety of our workforce, members and communities we serve, Fallon Health now requires all employees to disclose COVID-19 vaccination status. As of 2/1/2022 all roles not designated as “Remote” require full COVID-19 vaccination and Fallon Health will obtain the necessary information from candidates prior to employment to ensure compliance. Failure to meet the vaccination requirement may result in rescission of an employment offer or termination of employment.

JT18

Location US-MA-Worcester

Posted Date 2 weeks ago (1/11/2023 1:16 PM)

Job ID 7152

# Positions 1

Category Medical Management

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