ACO Market Manager

The ACO Market Manager position is responsible for all aspects of planning and delivery of operational programs. Manages initiatives through advanced skills in project management and strong organizational relationships. Addresses financial, quality, and operational improvement related to key program metric outcomes, partnerships, and new initiatives designed to improve the reach and engagement of physician partners and beneficiaries. Position will work closely with the Director on developing market-level strategic vision and implementation of programs and projects with internal and external stakeholders. Responsible for coordination of Board and physician pod meetings, planning, and leadership activities.

Department: UAM - ACO - Network

Reports to: Director, ACO

Location: Remote (Must be located in Maryland or Virginia)


Essential Functions:

  • Maintains primary operational relationship with physician practices and partners in the market.
  • Direct day to day operations of the ACO and activities of Quality Practice Advisors and Patient Care Advocate roles and other personnel or consultants as appropriate.
  • Responsible for the delivery of strategic operational programs that address gaps in coding, processes, and corporate goals. Works with ACO Director to ensure the program strategy meets goals of the ACO. Oversees aspects of program planning, management, and execution (scope, schedule, and budget. Responsible for creating program timelines including sign-off from all work streams.
  • Serves as first escalation point for program concerns and questions from participating physician practices for operational needs. Works directly with practice teams and internal staff to resolve issues and create risk mitigation plans. Responsible for escalating well-formulated issues and risks to leadership. Can effectively communicate business and technology issues and solutions.
  • Drives program-level quarterly and annual reporting as per the program requirements. Uses reporting to increase visibility and proactive monitoring of the program performance. Responsible for reporting program progress to all levels of the organization.
  • Responsible for being actively engaged in operations programs to ensure proper communication of program development and changes are communicated to both leadership and participating physicians. Key programs include Annual Wellness Visits, Quality Measures, and HCC Coding initiatives.
  • Responsible for proactive management in areas such as risks that would affect the practice’s participation in the program. Prepare strategic analysis of potential business and/or operational opportunities as needed.
  • Responsible for developing and implementing operations based programs, internal and external, through all phases of the project lifecycle to achieve success in improving financial and utilization metrics and communication for all healthcare partners involved. Encourages collaboration and ensures that all viewpoints are represented and explored. Builds effective working relationships with physician practices and healthcare partners.
  • Works with internal and external team members to implement identified programs and best practices.
  • Takes a primary role in planning marketing events for practice managers and physicians.
  • Provides and coordinates training to providers and partners on programs and services.
  • Monitors operational program performance through activity dashboards and analytic reports. Identifies trends and patterns for opportunities for program development.
  • Works with Executive Director and the Board to identify and coordinate additional physicians.
  • Post GPRO provide ACO committees and individual providers/TINS with GPRO results. Identify target areas for improvement by practice/TIN. Work to develop improvement action plans by practice/TIN. Implement improvement activities through Quality Practice Advisors’s and schedule follow up to study efficacy.
  • Serve as the local operational leadership to ACO providers and ACO staff in general and specifically to prepare the ACO for taking on risk.
  • Implement robust provider engagement strategies to meet the goals of the ACO, such as goals agreed upon with VP for overall financial success of the ACO. Ex: Quality, Coding and QAI and pilot programs.
  • Responsible for management, training, mentoring and direct day to day operations of Market Quality Practice Advisor and Patient Care Advocate to include schedules, organization, time management, productivity inclusive of all aspects of role.
  • Responsible for management, training, mentoring and direct day to day operations of Market Quality Practice Advisor and Patient Care Advocate to include schedules, organization, time management, productivity inclusive of all aspects of role.
  • Responsible for developing and implementing operations based programs, internal and external, through all phases of the project lifecycle to achieve success in increasing financial and utilization metrics and communication for all healthcare partners involved. Encourages collaborative activities and ensures that all viewpoints are represented and explored. Builds effective working relationships with physician practices and healthcare partners.
  • Works alongside Clinical Programs Manager and regional team to collaborate and coordinate program development. Offer recommendations for program implementation, assigns and oversees program rollout. Reports outcomes.
  • Develops planning committee within ACO across all modalities of operations to educate and keep abreast of current and proposed changes to better prepare, explore strategies for such changes.
  • Implement provider engagement strategies to meet goals of the ACO. Ex-AWV completion strategies, Quality data collection workflow and capture, coding to highest level of specificity (HCC), etc.
  • Provide leadership to ACO providers and their staff.
  • Maintain relationship across all aspects of ACO for team building.
  • Conduct and participate in quarterly Practice administrator, office management, office staff meetings. Invite vendors as appropriate (Home Health, Medical Nutrition Therapy, Behavioral Health, etc.) to present best practices. Assign and oversee presentations.
  • Conduct and participate in ACO Committee meeting. Set agenda, invite vendors for presentations as appropriate, present current ACO status overview, program development, etc.
  • Review analytic reports to identify improvement activities specific to ACO overall performance as well at individual provider/TIN level. Work with ACO committees to develop strategies around target areas for improvement. Work with ACO committees to reengage non-engaged providers.
  • Responsible for implementation of operational based programs to achieve financial and utilization goals of the ACO. Collaborating with ACO committees to fully develop programs, gain insights for program development and implementation, vet external resources to support programs. Oversee pilot programs and report back to ACO committees prior to expanding program across all ACO partners.
  • Manage annual GPRO data collection for market. Provide guidance, training, portal entry oversight, ensure portal logic is in line with intent of measures, oversight of personnel to manage and meet deadlines. Maximize quality score results.
  • All other duties as assigned by the ACO Director and other ACO Leaders.
Additional Responsibilities:
    Candidate Education:
    • Preferred A Bachelor's Degree in Healthcare, Public Health, Nursing, Psychology, Health Administration, Social Work or related field
    • Required or equivalent work experience Within a managed care environment related to HEDIS record review, quality improvement, medical coding or transferable skill sets that demonstrates the ability to perform the role.
    Candidate Experience:
    • Required 5 years of experience in managing the strategy, implementation, and optimization of healthcare practice administration and/or operations
    • Preferred Other Expertise managing provider-facing (e.g., physician, hospital, etc.) communications, provider relations
    • Preferred Other Experience with a major health plan and/or medical practice with Medicare/Medicaid exposure required, with Accountable Care Organization experience
    Candidate Skills:
    • Intermediate Ability to work in a matrixed environment
    • Intermediate Ability to analyze and interpret financial data in order to coordinate the preparation of financial records
    • Intermediate Demonstrated interpersonal/verbal communication skills
    • Advanced Ability to drive multiple projects
    • Advanced Other Strong facilitation and presentation skills
    Licenses and Certifications:
    A license in one of the following is required:
    • Preferred Certified Coding Specialist (CCS)
    • Preferred Licensed Practical Nurse (LPN)
    • Preferred Licensed Master Social Work (LMSW)
    • Preferred Licensed Vocational Nurse (LVN)
    Technical Skills:
    • Required Intermediate Microsoft Word
    • Required Intermediate Microsoft Excel
    • Required Intermediate Microsoft Outlook
    • Required Intermediate Microsoft Project
    • Required Intermediate Microsoft PowerPoint
    • Required Intermediate Adobe Acrobate
    • Preferred Intermediate SharePoint
    Languages:

      About us
      Headquartered in Tampa, Fla., WellCare Health Plans, Inc. (NYSE: WCG) focuses primarily on providing government-sponsored managed care services to families, children, seniors and individuals with complex medical needs primarily through Medicaid, Medicare Advantage and Medicare Prescription Drug Plans, as well as individuals in the Health Insurance Marketplace. WellCare serves approximately 5.5 million members nationwide as of September 30, 2018. WellCare is a Fortune 500 company that employs nearly 12,000 associates across the country and was ranked a "World's Most Admired Company" in 2018 by Fortune magazine. For more information about WellCare, please visit the company's website at www.wellcare.com. EOE: All qualified applicants shall receive consideration for employment without regard to race, color, religion, creed, age, sex, pregnancy, veteran status, marital status, sexual orientation, gender identity or expression, national origin, ancestry, disability, genetic information, childbirth or related medical condition or other legally protected basis protected by applicable federal or state law except where a bona fide occupational qualification applies. Comprehensive Health Management, Inc. is an equal opportunity employer, M/F/D/V/SO.