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Director of Population Health Clinical Programs

The Director of Population Health Clinical Programs leads the strategic planning, execution, and evaluation of Health New England’s Population Health clinical programs for members of our commercial products, Medicare programs, and self-funded groups. The Director, in conjunction with the Director of Quality and Population Health Analytics and the Healthcare Innovation Leadership Team, develop and drive HNE’s Population Health program strategy. The Director provides operational leadership for care management, behavioral health, and medical utilization management, in coordination with clinical leadership for all lines of business. The incumbent will oversee delegated functions and vendor management in these disciplines to ensure that regulatory and NCQA compliance are met for the organization. The Director reports to the Chief Medical Officer and is a member of the Health Innovation Leadership Team and serves as a representative on the Health New England Directors’ team.

Essential Functions:

Strategic Planning - 10%
The Director takes an active role in the development, implementation, and evaluation of the strategic plan for the Health New England clinical and population health programs to address cost of care, quality of care, and population health goals. Facilitates development of integrated member focused programs to include all aspects of member health including medical care management, integrated behavioral health, social determinants of health, and pharmacy services. The Director represents Health New England throughout the Baystate Health integrated healthcare system as it relates to the HNE Population Health strategy. They will present their plan and provide regular updates to the ELT and Board of Directors

Population Health Management - 20%
Works in tandem with the Director of Quality and Population Health Analytics to use claims data and risk stratification to develop and execute Health New England’s population health programs. Provides input into assessment of population based risk stratification reports, development of goals, clinical programs and targeted intervention development, and integration of community resources. Key participant in the annual review to assess impacts of programs with respect to clinical outcomes, cost/utilization and member experience and to suggest improvements.

Clinical Operations and People Management - 50%
Oversees clinical services managers and clinical operations associates in leading daily operations of their respective disciplines. Works with direct reports to develop and execute their annual work plans tied to HILT and company key priorities. Directs the review of metrics and reports related to utilization management for medical care management and behavioral health services and identifies gaps and opportunities for improvement relative to service, NCQA and regulatory standards. Makes recommendations for development or enhancement of medical cost management programs to impact trends and achieve goals for total medical expense. Oversees effective services and outcomes for members by monitoring the care management activities and ensuring compliance with regulatory and delegated activities. Facilitates integration of behavioral health strategy into the general medical care management process. Assures team members understand, monitor and reports key quality indicators and other measurement tools on a regular basis.

Clinical Integration - 10%
Collaborates with and coordinates HNE care management activities with provider- led care management programs. Supports programs and processes that address system-wide continuum of care that ensures on -going strategic collaboration as a system. Participates in Baystate Health system-wide committees as needed to ensure the coordination of activities occurs so members have the most effective experience with care management.

Support for Sales and Provider Relations - 10%
Works with the Health New England Sales Team and Provider Relations to identify and resolve concerns of employers, members and physicians. In conjunction with Medical Directors and Pharmacists, reviews and assists in the preparation of clinical and financial data to various audiences for providers, employers and other key stakeholders. Assures that appropriate clinical representation is available for presentations.

• Regulatory: Manage regulatory and accreditation compliance activities (NCQA, DOl, EOHHS, CMS) relative to clinical programs.
• Vendor management: Manages vendor relations for software or other relevant products and services.

Minimum Requirements:
Bachelor’s degree in population health or a health care field (Master’s degree preferred) with 8 or more years of progressive clinical leadership experience working in health plans, health systems, or provider organizations managing clinical and population health programs; or an equivalent combination of education and experience.
• Business acumen: Solid understanding of business concepts and strategic alignment. Demonstrated knowledge of care management, utilization management and managed care.
• Strong member, provider, customer focused
• Experience with government programs, knowledge of Medicare Advantage is a plus
• Analytical, quantitative and metrics driven; must know how to interpret data and reports to drive improvements.
• Experience managing day-to-day operations, managing multiple projects, and driving for results
• Collaborative mindset – able to listen actively, develop buy- in, and drive action across a broad set of stakeholders.
• Demonstrated competencies including influence management, collaboration and negotiation
• Experience working in a high demand, multi-tasking environment
• Ability to prioritize, plan and manage multiple projects independently and effectively
• Demonstrated critical thinking, problem solving and conflict management skills
• Analysis and data driven to improve processes and measure results
• Excellent verbal, interpersonal and written communication skills
• Strong leadership, emotional intelligence and political savviness skills
• Seasoned facilitator with strong presentation skills

Physical Requirements: List any physical requirements of the job such as standing, kneeling, lifting, carrying, pulling, pushing, traveling, working frequent overtime, etc. Include requirements for amount of weight lifted or carried if appropriate, e.g., must be able to lift and carry 25lbs. Also include percent of time individual will be engaged in these activities.

Data Entry Continually (5 1/2 - 8 hrs)
Hearing Continually (5 1/2 - 8 hrs)
Seeing Continually (5 1/2 - 8 hrs)
Sitting Continually (5 1/2 - 8 hrs)
Travel Frequently (2 1/2 - 5 1/2 hrs)

Supervisory Responsibilities: List all positions reporting to this position and indicate whether they are direct or in-direct reports.
• Manager for Care Management
• Manager for Utilization Management
• Manager for Behavioral Health
• Integrated Care Quality Specialist
• IT Business Systems Analyst
• CSI Support Specialist
• Health Services Vendor Specialist

Time:  Full time
Salary:  Salary
Category:  Clinical/pharmacy/quality

Updated: 6/21/2019 11:57:23 AM

Job Contact:
Elisa Rose

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1 Monarch Pl
Springfield, MA 01144-1500