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This position is responsible for the operational and financial performance for two or more ACOs in a specific geographic region, including the following key areas: Achieving profit and loss goals for the ACO through delivery system transformation, establishing the local system of care and operational integration, prioritizing the health care transformation topics to fit local conditions, creating a lasting engagement with the ACO providers, enabling them to use data effectively to coordinate care and reduce inappropriate care, Leveraging the ACO provider relationships to anticipate expand into new risk-based businesses; for example Next generation ACOs, Track 1 , Track. It is expected that the ACO Director will seek and provide, best practices to/from their peer group and other ACOs for which they are responsible. Each ACO will test and implement new medical management techniques and technologies to determine effective and efficient care innovations that achieve the triple aim. This is a role that requires demonstrated excellence in creating buy-in and engagement with both ACO providers, as well as, other community constituents.
Direct day to day operations of the ACO and activities of Market/Network Management Staff, Clinical Manager and other personnel or consultants as appropriate
Serve as the local senior operational executive, providing leadership to ACO providers and ACO staff in general and specifically to prepare the ACO for taking on risk by year 4 of the MSSP program.
Develop and implement robust provider engagement strategies to meet the goals of the ACO, such as goals agreed upon with SVP/VP for Annual Wellness Visits, Quality Management data collection, Advanced Partnership Programs and other pilot programs, etc.
Translate analytic reports and tools to local performance improvement actions; work closely with ACO Management Committees, and engaged providers enabling them to target specific areas for improvement and in turn for them to target non-engaged providers. Develop approaches to engage non-engaged providers.
Anticipate and respond to local competitive/competitor actions; thoroughly understand strategies and tactics of local competitors, and be able to explain to providers the competitive advantages of pursuing relationships with CHS ACOs.
Prepare ACO Management Committee leadership for strategic and operational requirements, to include but not limited to: provider quality level performance, documentation standards, practice engagement and compliance with ACO policies and procedures.
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.
Oversee and create actions plans to meet quality, utilization and engagement goals of the ACO using Clinical Managers and Market Managers.
Manage Annual GPRO CMS data collection in partnership with providers and appropriate healthcare partners; provide clear training and guidance, maximize the Quality Score results, and utilize personnel/provider entry as appropriate. Achieve a minimum score of 90%.
Assist Management Committees and Providers to understand their GPRO results. Identify key areas for improvement and strategies and tactics to improve individual Provider/TIN performance.
Develop professional, effective relationships with local hospitals and ancillary providers outside the ACO.
Actively participate in the Advanced Practice Program at a local level, assessing Provider Interest and conducting implementation to maximize success and savings.
Assist in applications for, and start-up of, new ACO Plans, including Next Generation and MSSP. Write applications in conjunction with other assigned staff in a matrixed organization. Meet all goals in a timely and accurate fashion. Conduct all required and appropriate activities to start-up the ACO.
Participate in a cooperative and productive function with Compliance and other assigned staff when responding to CMS, CMMI, or other audit requirements.
Balance/manage the above demands across multiple ACOs and geographic environments.
Complies with all guidelines established by the Centers for Medicare and Medicaid (CMS) and guidelines set forth by other regulatory agencies, where applicable, and defined in the WellCare Corporate and department policies.
All other duties assigned by the Regional VP or SVP.
Required - A Bachelor's Degree in Health Care Administration, Business Administration, Marketing, Health Service
Preferred - A Master's Degree in a related field
Required - 7 years of experience in managing the strategy, implementation, and optimization of healthcare practice administration and/or operations
Required - 5 years of experience in managing provider-facing (e.g., physician, hospital, etc.) communications, provider relations
Required - 5 years of experience in Complex Project Management and Implementation
Preferred - 5 years of experience in Experience with a major health plan and/or medical practice with Medicare/Medicaid exposure required, with Accountable Care Organization experience
Ability to work in a matrixed environment
Ability to effectively present information and respond to questions from peers and management
Ability to influence internal and external constituents
Demonstrated interpersonal/verbal communication skills
Ability to drive multiple projects
Required - Intermediate proficiency working with Microsoft Office Suite