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Description

Leaders thrive with us! HCA Healthcare is one of the nation’s leading providers of healthcare services, comprising of over 180 hospitals and about 2,000 sites of care in 21 states and the United Kingdom. We are looking for a Medical Director for our Mission Health Partners team where excellence creates excellence. Mission Health Partners (MHP) is one of the largest Accountable Care Organizations in North Carolina, with value-based agreements in place with payors that allow MHP to provide care coordination services for at-risk patients under these health plans while also providing incentives for physicians to improve quality and reduce unnecessary costs. The Medical Director works collaboratively with Mission Health Partners (MHP) administrative leadership and clinical staff in the overall clinical management of the network and its care teams. Maintains shared accountability for decisions regarding MHP strategic planning and goals, direction, and development of clinical protocols to assure evidence-based best practices.

What qualifications you will need:

• Required Education: M.D. or D.O. Degree.
• Preferred Education: Master’s degree in Business or Healthcare Administration.
• Required License: Current M.D. license in North Carolina is required.
• Required Memberships: Buncombe County Medical Society Membership is required.
• Required Experience: Ten or more years of demonstrated progressively responsible medical experience. Demonstrated knowledge of the laws and accreditation standards applicable to hospitals is necessary.

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Or you can go to HCAHealthcare.com/careers and search Medical Director in North Carolina on our main website.

This role works with matrix partners across the organization to educate and manage provider performance expectations focused on quality measure outcomes, risk improvement and overall performance to financial targets in Health Partner’s value-based programs. Monitors and shares individual and group performance in regular face-to-face meetings using Key Performance Indicators (KPIs). Engages with providers and office staff to build trust and shift the way providers think about value-based care. Shall promote all clinical programs available as a resource to facilitate full engagement and improve outcomes. Shall play a critical role in fortifying the collaborative relationship we seek to establish with our physicians at the practice level.

Minimum Job Qualifications
Educational Requirements: Bachelor's degree in Business, Healthcare, Information Science, or related field

Minimum Experience:
Minimum of 5+ years experience with increasing responsibilities in developing and executing risk coding programs. Knowledge of, and experience with, utilizing EPIC EHR. Knowledge of, and experience with, health plan value-based arrangements, alternative payment models, healthcare risk quality, and population health outcomes. CRC (Certified Risk Coder) certification (Preferred but not required)Job Specific and Unique Knowledge, Skills and Abilities Experience leading program development and management efforts involving provider/partner engagement and implementation. Experience developing and monitoring delivery of efficient and effective solutions to diverse and complex business problems. Demonstrated ability to embrace and utilize technology and other innovative solutions to deliver enhanced processes and results for provider partners. Expertise in creating training materials and delivering user training. Ability to establish strong relationships and maintain a high level of trust and confidence. Exceptional communication skills, internally and externally, with the ability to convey key messages and influence stakeholders and to convey technical concepts in easily understood ways. Strength in problem-solving based on experience, subject matter expertise, and objective data analysis. Comfortable working on simultaneous and diverse projects and activities. Self-directed, ability to execute projects with minimal supervision. Excellent time management skills with a proven ability to meet deadlines. Ability to work under pressure with urgency and speed while maintaining a high degree of accuracy. Ability to communicate comfortably and effectively at all levels of organization to achieve results. Effective use of Microsoft Office software (Outlook, Excel, PowerPoint and Word). Essential Tasks and Responsibilities Shall develop a comprehensive risk coding accuracy program and curriculum in dyad with matrix partners to include leveraging effective efforts underway within the provider groups Leads collaborative efforts to design and create content-specific internal and external risk adjustment training curriculum and programs Shall set priorities for RA staff in a manner that executes on the right set of initiatives to improve risk scores Shall develop and or identify quality, risk score and financial KPIs that reflect each provider’s contribution towards goals for all contracted payer relationships Shall use dashboards and other reporting tools available from EPIC and or the payers to convey performance trends to providers, groups, and leadership Shall partner with providers and clinical/administrative staff to enhance understanding of clinical documentation improvement goals to achieve risk adjustment strategic goals and objectives Coordinate and deliver programs through flexible approaches including onsite, classroom, remote hosted, and self-service web-based models Design, execute, and report on evaluation methods and key performance indicators to measure results, identify risks/barriers to project rollout, timely deliverables, and adoption success Shall work in close partnership with Health Partners’ care management and quality teams to produce relevant material to share with the providers Shall participate in rolling out new programs and services to providers as they are developed Shall travel to Health Partner provider locations to oversee and execute engagement and shall document all visits in a standard format and retain for future reference Shall create organized presentations and other content to present to various committees and the Board Shall demonstrate the ability to be a strong people performance manager with the ability to motivate staff and drive results Ability to analyze project needs and determine resource requirements to meet objectives and solve problems that span multiple interdisciplinary teams and environments Shall build relationships and communicate with external and internal parties to deliver key messages, influence stakeholders, manage expectations, and shape outcomes

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The Medical Director of Accountable Care is the physician executive for accountable care across Stanford Health Care (SHC) and Stanford Medicine Partners (SMP) and provides medical leadership and direction to the clinical teams responsible for accountable care delivery. This enterprise leader develops innovative care models and clinical interventions focused on management of patient populations and provides oversight of provider performance in achieving value-based care. The Medical Director of Accountable Care works closely with Accountable Care, Quality and Operational leaders to define strategic priorities and goals for Accountable Care, and collaborates closely with medical, operational, finance and quality leadership, to achieve desired outcomes. This leader works within a highly matrixed environment to facilitate awareness and alignment with key leaders, physician groups, individual physicians, and external stakeholders. Reports to Associate Chief Medical Officer for Ambulatory Care. Commitment to effort: 100% FTE

EDUCATION QUALIFICATIONS:
Doctorate required. Candidates may be Physician MD or DO

EXPERIENCE QUALIFICATIONS:

1. At least five years of experience in a similar role, with experience as a leader in a large matrixed organization strongly preferred.
2. Strategic thinking and business acumen with the demonstrated ability to align clinical strategies with business objectives.
3. Operational focus with demonstrated data analysis/interpretation acumen, project management, change management, and execution skills.
4. Extensive knowledge of managed healthcare systems, medical quality assurance, quality improvement and risk management.
5. Track record of successful leadership of case management, disease management, and Accountable Care programs.

Email Trina Nand for the full job description!

PURPOSE

The ACO Operations Manager will provide day-to-day oversight to Wilmington Health’s client groups participating in the Accountable Care Organizations associated with Wilmington Health’s Management Services Organization (MSO), Block Ops. This position will facilitate and support program governance, operations and communication strategies for our MSO ACOs which includes the development and maintenance of project plans, quality initiatives, cost containment, and patient experience initiatives.

Essential Duties/Responsibilities

Maintains knowledge regarding ACO policies and procedures, governance structure and regulatory requirements through ongoing research and regular attendance at training webinars. Utilizes standard project management tools and principles to define and manage project scope, monitor timelines and deliverables, and communicate and identify pathways to resolve risks and barriers. Oversees and maintains effective communication with stakeholders using communication plans, status reports, dashboard and various media sources tailored to the audience. Effectively plans and facilitates meetings of varied participants using standard meeting management tools and techniques (e.g. agendas, meeting roles, ground rules, minutes, action item tracking) including support of meeting logistics for ACO Boards and committees. Leads process improvement, new workflow development, enhancement through support of and collaboration with practices to drive performance on contract quality and equity metrics. Works collaboratively with practices and providers to develop campaigns to address gaps in care, monitors patient and practice/provider compliance with campaigns and provide feedback and adjustment as needed to ensure success. Leads planning efforts to enable the Block Ops team to effectively achieve high performance in risk-based contract quality and equity metrics and ensure compliance with regulatory agencies. In collaboration with the WH ACO and analytics teams, develops comprehensive operation for clinical data acquisition, reporting, and workflow development in support of quality measure improvement. In collaboration with local leaders, informs the redesign of local workflows to drive performance in quality and equity metrics. The Compliance Officer will create, maintain, and audit the ACO’s Compliance Plan and provide regular reports to the Governing Body of the ACO. Establish and maintain a method for employees or contractors of the ACO, its ACO Participant Provider and Preferred Providers, and other individuals or entities performing functions or services related to ACO Activities or Marketing Activities to anonymously report suspected problems. Work with the Wilmington Health Compliance Officer to receive claims analysis to identify potential fraudulent behavior or program integrity risks, such as inappropriate reductions in care, effort to manipulate risk score or aligned populations, overutilization, and cost-shifting to other payers or populations. Audit chart, medical records, Implementation Plans and other data from the ACO, its ACO Participant Providers and its Preferred Providers. Cooperate with all CMS monitoring and oversight requests and activities. Ensure compliance with all applicable state licensure requirements regarding risk-bearing entities in each state in which the ACO operates. In a form and manner and by a deadline specified by CMS, the ACO shall submit to CMS documentation demonstrating its compliance with the requirement set forth in the Agreement. Ensure compliance with all plans submitted to CMS for benefit enhancements or waivers. Ensure that the ACO has appropriate procedures in place to ensure that ACO Participant Provider and Preferred Providers have access to the most up-to-date information regarding Beneficiary alignment to the ACO.

QUALIFICATIONS

Required: 3+ years’ experience in healthcare, with value-based care models (CMS MSSP, ACO REACH, Commercial full or partial risk contracts).Demonstrated understanding of healthcare clinic models, HEDIS measures, STAR ratings, documentation processes, and strategies to close gaps in care and support caring for high and rising risk patients with multiple chronic conditions. Strong expertise with MS Excel, MS Teams, and PowerPoint. Preferred: 5+ years’ in healthcare operational management Demonstrated understanding and experience with SQL queries and analytics, understanding of risk stratification models, and the ability to translated data-driven insights into clear clinical priorities and interventions. Bachelor’s Degree in Healthcare or Business Administration.

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The CareNu Senior Accountant is responsible for implementing and maintaining accounting processes and records; performing analysis of source transaction files, data, and documentation; and preparing journal entries, reconciliations, financial statements, and pro forma financial reports.

See job responsibilities, qualifications and more.

This role works with matrix partners across the organization to educate and manage provider performance expectations focused on quality measure outcomes, risk improvement and overall performance to financial targets in Health Partner’s value-based programs. Monitors and shares individual and group performance in regular face-to-face meetings using Key Performance Indicators (KPIs). Engages with providers and office staff to build trust and shift the way providers think about value-based care. Shall promote all clinical programs available as a resource to facilitate full engagement and improve outcomes. Shall play a critical role in fortifying the collaborative relationship we seek to establish with our physicians at the practice level.

Minimum Job Qualifications

• Licensure or other certifications:
• CRC (Certified Risk Coder) certification.

Educational Requirements

• Bachelor's degree in Business, Healthcare, Information Science, or related field

Minimum Experience

• Minimum of 5+ years experience with increasing responsibilities in developing and executing risk coding programs.
• Knowledge of, and experience with, utilizing EPIC EHR.
• Knowledge of, and experience with, health plan value-based arrangements, alternative payment models, healthcare risk quality, and population health outcomes.

Apply Now!