The Director, Integrated Health Homes (IHH) will be responsible for managing staff charged with the successful delivery of the Integrated Health Home Program. This includes ensuring that each member in the Medicaid population will be linked to an Integrated Health Home provider based on their level of need and the provider's ability to meet those needs. The incumbent will be accountable for monitoring the performance and compliance of participating providers and ensuring that the program is operated in accordance with state guidelines and regulations.
- In coordination with staff, responsible for the delivery of the strategic IHH Program.
- Responsible for provider education, serving as a resource for providers who have questions or require assistance with the program.
- Monitors performance and compliance of participating providers.
- Manages reimbursement and incentives for improved IHH provider performance.
- Works with Clinical leadership and ancillary care teams to ensure the program adheres to state clinical guidelines and regulations.
- Serves as the escalation point for program concerns and questions from participating providers and works with infernal cross functional staff as well as provider staff to resolve issues and create risk mitigation plans.
- Ensures providers comply with State requirements including technical and staffing requirements and performance on quality measures.
- Facilitates partnership between WellCare, State and Providers deploying a variety of assessment approaches to ensure compliance on a broader set of requirements, incentives and sanctions to drive changes in the case of underperformance.
- Responsible for escalating well-formulated issues and risks to leadership and effectively communicates business and technology issues and solutions.
- Drives program-level reporting and leverages results to increase program visibility and to proactively monitor performance. Responsible for reporting program progress to all levels of the organization.
- Supports the successful enrollment of members into IHHs and/or the transfer of members and medical records between Integrated Health Homes.
- Participates in contract negotiations with healthcare partners to ensure expectations are established and maintained through the duration of the program.
- Responsible for proactive risk management that may affect provider participation in the program. Prepares strategic analysis of potential business and/or operational opportunities as needed.
- Monitors IHHs' performance on care delivery, providing IHH's with necessary input to support the development of individual plans of care, and ensure that members have access to covered services.
- Performs other duties as assigned.
This position is contingent upon the bid award in the state of Illinois to WellCare Health Plans, Inc.