Senior Director Clinical Programs - Remote - Military Veterans
at Martin's Point Health Care, Inc.
Senior Director Clinical Programs - Remote
REQ-2024-305
Portland, ME
Join Martin's Point Health Care - an innovative, not-for-profit health care organization offering care and coverage to the people of Maine and beyond. As a joined force of \"people caring for people,\" Martin's Point employees are on a mission to transform our health care system while creating a healthier community. Martin's Point employees enjoy an organizational culture of trust and respect, where our values - taking care of ourselves and others, continuous learning, helping each other, and having fun - are brought to life every day. Join us and find out for yourself why Martin's Point has been certified as a \"Great Place to Work\" since 2015.
Position Summary
The Senior Director Clinical Programs provides oversight and coordination of care management and disease management related activities, objectives, and analysis for the Martin's Point Health Plan. The Senior Director is responsible for Care Management design, implementation and operations and will work closely with VP of Health Plan Clinical Program and Director of Health Management to ensure the clinical departments can support enterprise-level growth, clinical outcomes, and medical trend targets. This includes creating new or redesigning existing product programs to achieve the triple aim.
The Senior Director Care Management leads a team to execute on program strategy, design and implementation through project management, and the ability to foster support for program enhancements across all levels of the organization. Partnering with all Health Plan and shared service departments, the Senior Director Care Management will support the above through coordination of government and regulatory affairs, industry best practices and innovation, population health strategies and clinical integration.
Job Description
Key Outcomes:
- Proposes and plans new programs and services to meet population health needs, customer expectations, and activities to manage medical costs and focus on health outcomes.
- Develops objectives across the department to ensure compliance with professional and regulatory standards, federal contracts, and accreditation standards.
- Develops and leads high performing care management coordination activities to reduce cost per capita for all member populations while ensuring members receive appropriate and needed services.
- Leads care management and disease management activities for Martin's Point to improve clinical and medical trend outcomes.
- Oversees all reporting to monitor the progress and outcomes of all care management and disease management activities carried out by the department including reporting to regulatory and accrediting agencies.
- Manages relationships and coordination with external vendors and delegated entities. Responsible for Delegation Oversight of Clinical vendors
- Develops and manages Key Performance Indicators (KPIs) for care management and disease management.
- Partners with cross functional teams to successfully enhance existing clinical program's structure to address the needs of members, support the work of care teams, and align with our company objectives.
- Proposes, designs, and oversees implementation of care management redesign and new products and services to meet population health needs, customer expectations, and activities to manage medical costs and focus on health outcomes.
- Ensures all program design and redesigns are in compliance with professional and regulatory standards, federal contracts, and accreditation standards.
- Collaborates across health plan clinical programs as well as other key health plan departments and the delivery system to ensure alignment of clinical and operational initiatives and activities.
- Collaborates with the Director Health Plan Quality to support initiatives such as HEDIS, Member Safety, QIPs, QII's, CMS Stars and accreditation.
- Collaborates with clinical teams across Health Management synthesizing clinical outcome drivers and quality/operational requirements into an aligned program, strategy to deliver high-impact clinical outcomes, client value and business results.
Education/Experience
- Bachelor's degree in a clinical field of study (RN, Pharmacy, etc.); Master's degree in nursing or related field preferred
- 10 years of experience in health care including experience in care management/ disease management, utilization management and prior authorization.
- Experience developing and managing health plan program strategy, design, redesign, clinical platform conversions, implementation, and evaluation.
- Experience using data and data analysis to design programs, manage care coordination services, and manage success of programs.
- Strong project management experience required.
- Experience in Medicare Advantage and TRICARE preferred.
Required License(s) and/or Certification(s):
- RN, NP, PA, PharmD or similar level of clinical licensure
Skills/Knowledge/Competencies (Behaviors):
- Broad knowledge of managed care and health plan functions; Medicare Advantage required; USFHP and/or TRICARE knowledge is a plus
- Demonstrated project management skills overseeing complex projects in matrix environment.
- Strong attention to detail and the ability to multitask.
- Excellent communication and presentation skills, oral and written.
- Demonstrates an understanding and alignment with Martin's Point Values
- Knowledge of NCQA/URAC accreditation as well as CMS requirements, and State and Federal regulations
- Knowledge of Medicare Advantage regulations, CMS Stars, and HEDIS.
- Knowledge of reimbursement models, utilization patterns, and quality improvement opportunities
- Strategic ability to see the big picture and lead a team through change
- Ability to operationalize a concept
- Strong organizational skills including the ability to work independently and prioritize work.
- Ability to review, interpret and present information to Health Plan Leadership and external partners.
- Ability to lead change and assist in the development of change strategies in support of Health Plan and Organizational goals and objectives.
- Competence with computers and business applications; Microsoft Excel, Word, PowerPoint, Outlook, Access.
- Excellent written and verbal communication skills with the ability to write executive reports and power point presentations as well as the ability to present findings in internal and external settings.
This is a remote position with occasional travel to Portland, Maine.
We are an equal opportunity/affirmative action employer.
Do you have a question about careers at Martin's Point Health Care? Contact us at: jobinquiries@martinspoint.org
To apply, visit https://martin.wd1.myworkdayjobs.com/en-US/MPHC/job/Portland-ME/Senior-Director-Clinical-Programs_REQ-2024-305.
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Portland, ME
Martin’s Point Health Care is an innovative not-for-profit health care organization offering high-quality, affordable health care and coverage to the people of Maine and throughout New England. Martin’s Point has seven health care centers in Maine and New Hampshire offering primary and specialty care to those with most major health insurance plans. Martin’s Point also administers two health insurance plans: Generations Advantage—with the only 5-Star Medicare Advantage plans in northern New England, and the US Family Health Plan for active duty military families and retirees throughout most of northern New England and New York. We believe that understanding both the clinical and health plan administrative side gives us the insight we need to make meaningful improvements to the health care system. Martin’s Point is dedicated to creating a community of healthy people through authentic relationships and trust.