Director
Location: Baltimore, Maryland
Description: CareFirst BlueCross BlueShield is in need of Director right now, this job will be arranged in Maryland. More details about this job opportunity please give attention to these descriptions. Under the general direction of a Vice President, Regional Care Coordination, the incumbent’s accountabilities include, but are not limited to, the following:
Builds relationships with practitioners and panels, and champions the PCMH concept within all PCMH practices (panels) within a designated region. Serves as the Subject Matter Expert on PCMH in the field, and is responsible for practitioner and panel comprehension and adoption of PCMH/TCCI core concepts.
Serves as the initial representative to introduce the PCMH Program details to enrolled practitioners; works to confirm Primary Care Physician (PCP) buy-in and agreement to work with Local Care Coordinators (LCC) to collaborate in managing their patients. Maintains ongoing positive provider relationships and provides the framework and oversight for effective care coordination workflows between PCPs and LCCs.
Acts as Subject Matter Expert for all TCCI programs in the CareFirst PCMH program, describes the clinical significance of those programs, and leads regional team to educate and inspire panels of PCPs and their staff to assist in their achievement of self-sufficiency in operational aspects of the program. Continuously drives awareness and appropriate use of TCCI programs. Assures appropriate members selection.
Builds and maintains a solid professional relationship with all assigned PCMH offices and is proficient and knowledgeable about the PCMH model. Communicates regularly with the PCMH Sr. Leadership on the operational issues/concerns and barriers identified from the field work with practices.
Communicates to practices any program updates/changes as they occur and works with delegate to improve identified deficiencies, and prioritize opportunities.
Partners with other CareFirst departments, including Networks Management, to maximize PCP engagement and program participation.
Continuously assesses the engagement status of PCPs and panels in an effort to influence those who fully understand the program to more fully leverage all aspects of the program to impact quality outcomes and cost savings, and to ensure that those providers and panels not making any effort are discharged from further participation in the program. Develops and maintains physician champions and identifies accurate Designated Provider Representatives (DPRs).
Drives the success of the program through the management of the clinical programs, the organization and management of the Panel’s data and the ability to impact and implement change in a challenging environment.
Oversees population health management and subsequent bending of healthcare cost curve for their Region using all aspects of TCCI. Develops regional business plan considering programmatic goals and current state of performance, and establishes a roadmap for success related to the alignment of people, processes, and technology.
Proactively guides PCPs regarding which specialists, facilities, and resources are designated cost-efficient and encourage PCP to weigh with quality outcomes.
Maximizes the role of the Practice Consultant and Physician Advisor for PCP education and awareness of opportunities to improve quality and decrease the cost curve. Identifies strategic and tactical levers and resources in an effort to influence and support a panels to design and implement practice transformation activities. Provides clinical support to the Practice Consultants.
Understands SearchLight resources and leads the Practice Consultant(s) ensuring that they are utilizing these resources to engage PCPs and meet overall goals of decreasing the cost curve.
Establishes the guardrails of success for the panel and impacts the success through the various opportunities available to the Providers. Knowledge and experience drives the strategies, based on Providers unique differences and practice patterns.
Oversees the Care Planning process and care coordination ensuring clinical quality.
Assures that the Providers and Office Staff have a clear understanding on the Core Target Population, Chronic Kidney Disease Population and the Pharmacy Programs. Provides direction and guidance on appropriate member selection balancing the overall cost of coordination with the desired outcome.
Responsible for Regional oversight of care plan extensions past a 6 month length of stay as well as approval for the emerging Core Target members identified by the provider.
Reviews the progress notes and weekly regional report for each LCC to identify quality issues and or opportunities for improvement.
Responsible for the successful implementation of all Clinical Programs within the Region and the metrics that impact the engagement of the provider.
Works with PCPs and LCCs to identify appropriate patients. Responsible for the quality of care coordination for the region; coaching LCC to success with care plan development and care coordination to ensure the plans are of high quality to meet patients’ needs.
Monitors quality and quantity of care plans for each LCC to include use of other TCCI programs as clinically appropriate.
Effectively uses metrics to drive performance and achieve productivity goals for the region.
Provides effective leadership of a multi-faceted team and participates as a member of management providing thought leadership and contributing to overall business development and execution.
Continuously monitors and evaluates staffing and distribution of LCC, BHCC, HTC and Practice Consultant resources across the Region to meet program and divisional goals.
Leads team of LCCs in partnership with Healthways HR team to ensure LCC training, engagement and performance expectations are clearly understood and accomplished. Supports the Senior Leadership Team in the development of CareFirst Practice Consultant(s), with the goals of developing and retaining talent within the organization.
Evaluates performance of each team member, generates development plans and sets goals within the context of the corporate policy. Provides coaching, counseling and motivation to team members ensuring staff has the appropriate tools and support to be successful in their roles, while holding individuals accountable for individual and team goals.
Creates a team oriented work climate that enables professional development and encourages creative solutions and strategies.
Partners with Healthways and PCMH Leadership to ensure that best practices are in place.
Helps to enhance and guide the evolution and success of PCMH Program through participation in multiple CareFirst initiatives, often providing strategic and tactical input.
Actively supports PCMH workgroups and special projects including: User Acceptance Testing of IT systems, provider relations involvement, etc.
QUALIFICATION REQUIREMENTS:Required Knowledge and Experience:
Master’s degree in a health care or business discipline, or equivalent work experience
Minimum 7+ years of related experience working in Case Management, Home Health, or Disease Management or related clinical setting.
Must have evidence of position(s) with increasingly progressive leadership responsibilities.
A current DC, MD, or VA Registered Nurse License is required.
Must possess extensive knowledge of managed care delivery guidelines and systems.
Required Skills and Abilities:
The following competencies are required to perform the aforementioned responsibilities successfully:
Leadership/Coaching/Performance Management/Team Building
Strategic and Analytical Thinking
Staffing and Resource Planning
Planning and Organizing
Business Acumen
Relationship Management
Provider Education
Clinical Quality and Process Improvement
Influencing and Negotiating
Oral Communication and Presentation Skills
Project Management
Advanced proficiency in Microsoft Office Suite
Must be able to effectively work in a fast paced environment with frequently changing priorities, deadlines, and workloads that can be variable for long periods of time. Must be able to meet established deadlines and handle multiple customer service demands from internal and external customers, within set expectations for service excellence. Must be able to effectively communicate and provide positive customer service to every internal and external customer, including customers who may be demanding or otherwise challenging.
PREFERRED:
Sales or related experience in making calls to multiple “customers†is important.
Department
Department: Regional Care Coordination
Equal Employment Opportunity
CareFirst BlueCross BlueShield is an Equal Opportunity (EEO) employer. It is the policy of the Company to provide equal employment opportunities to all qualified applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, protected veteran or disabled status, or genetic information.
Hire Range Disclaimer
Actual salary will be based on relevant job experience and work history.
Where To Apply
Please visit our website to apply: www.carefirst.com/careers
Closing Date
Please apply before: 2/21/2018
Federal Disc/Physical Demand
Note: The incumbent is required to immediately disclose any debarment, exclusion, or other event that makes him/her ineligible to perform work directly or indirectly on Federal health care programs.
PHYSICAL DEMANDS:
The associate is primarily seated while performing the duties of the position. Occasional walking or standing is required. The hands are regularly used to write, type, key and handle or feel small controls and objects. The associate must frequently talk and hear. Weights up to 25 pounds are occasionally lifted.
Sponsorship in US
Must be eligible to work in the U.S. without Sponsorship
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If you were eligible to this job, please deliver us your resume, with salary requirements and a resume to CareFirst BlueCross BlueShield.
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This job will be opened on: Tue, 23 Jan 2018 04:21:57 GMT