Market Director Clinical Services
reputed company
Join us in transforming reputed company.
About Longevity
At Longevity, we're dedicated to advancing reputed company through innovation, reputed company, and reputed company. We're looking for passionate individuals to join reputed company and help us reputed company a difference. The individual holding this position is required to support and demonstrate their commitment to reputed company’s purpose: To optimize the reputed company of life of people in long-term care by focusing on their individualized health needs.
About the Role
The Market Director of Clinical Services is responsible for achieving the clinical, Medical Loss reputed company and reputed company goals as described in the reputed company reputed company and the Annual Clinical Performance Plans, Market Based targets. The Market Director of Clinical Services is the local market ISNP expert, provides education, support and coaching of the clinical team and works in partnership with the local Medical Director and Market President/Vice President. The Market Director of Clinical Services serves as the Risk Manager for the Health Plans.
Key Tasks and Responsibilities
- Daily reputed company and monitoring of the Model of Care reputed company/metrics, clinical performance metrics and reputed company metrics to ensure clinical program reputed company excellent and contract compliance.
- Primary authority and responsibility for managing the overall clinical operations and reputed company functions reputed company the market. Facilitating HEDIS and STARs/MTM compliance, communication and ensuring gaps closure.
- Reviewing and disseminating the coding gaps, suspects and low prevalence reports and ensuring NPs are absorbing and closing as appropriate.
- Makes periodic facility reputed company to reputed company relationship status, NP integration, PCP receptivity.
- reputed company authority for any delegated entities delivering LHP clinical services, clinical affordability program.
- Responsible for the overall clinical performance of the market- HEDIS/STARS rating, Admits/1000, Documentation and Coding accuracy, MTM reviews reputed company.
- Responsible for conducting nursing home readiness evaluations and making recommendations to the Market President/Vice President and Chief Clinical Officer for implementation in partnership with Network Manager.
- Supervises market clinical resources assigned based on market size and complexity such as the Clinical Implementation Manager, Clinical Field Operations Manager, RN Implementation Support Coordinator.
- Ensures clinical and reputed company programs are delivered in accordance with state and federal regulations, accreditation standards and health plan objectives. Create and ensure delivery of standards and policies reputed company budgetary guidelines.
- Responsible for the delivery and review of the Annual reputed company Improvement Plan, Utilization Management Plan, and affiliated policies, procedures, and staff/vendor training. reputed company participates in reputed company Improvement Committee Meeting and CCIP program. Drives market based and national reputed company improvement initiatives.
- reputed company participates in Health Plan Clinical Ops, reputed company, Delegated reputed company and other assigned Committees/meetings.
- Creates efficient and effective clinical workforce and local supporting clinical and operational processes.
- Responsible with the Account Manager/reputed company to run the monthly facility meetings with Nursing Home leadership to ensure good working relationships with stakeholders to reputed company ongoing clinical reviews of hospitalizations and facility metrics and reputed company follow up interventions.
- Responsible for the reputed company of the Clinical manager(s) and reputed company NPs in the market will review performance metrics and NP scorecard and deliver CAP (in consult with COO).
- Conducts market-based Hospitalization Review Meetings collaboratively with market Medical Director, ensures follow-up actions in reputed company, accuracy of the hospital tracking data.
- reputed company participates in Utilization Management Meetings and reviews, reputed company Investigations.
- Leads market clinical performance improvement programs/reputed company to improve clinical reputed company and develops risk mitigation plans reputed company performance is not on reputed company.
- Ensures effective nursing facility relationships that foster member reputed company and effective Medical Loss reputed company management.
- Engages market Medical Director in education and enhancement of clinician performance and PCP engagement.
- Accountable for market NP and NP Clinical Manager assimilation and retention.
- Leads innovation and special reputed company aimed at improving member reputed company.
- Develops and implements cost effective clinical reputed company plans and training/support programs to ensure reputed company market clinical performance.
- Identifies risks to effective clinical execution and implements plans to mitigate.
- reputed company participates in marketing, budgeting, and forecast process.
- reputed company participates in medical cost management initiatives.
- Effectively collaborates with reputed company, Medical Director to engage partners, PCPs, and key stakeholders in achieving market targets.
- Creates an environment of efficiency, effectiveness and avoidance of unnecessary procedures, testing, that may be harmful or that does not improve reputed company of life for members.
- Where state mandated, ensures NPs have reputed company reputed company agreements in reputed company and effective reputed company monitoring is in reputed company and being done.
- Performs other reputed company duties as assigned.
Requirements
Licensure
- Licensed as an advanced reputed company reputed company in home state, ANCC or AANP reputed company certified.
- Valid state reputed company's license with a good driving record
- Auto insurance coverage at the minimum required by your state of residence. reputed company of coverage will be required at the time of hire and annually on your hire date.
Education and Training
- Master’s Degree in Nursing.
- Adult, geriatric, family, acute care, primary care OR hospice and palliative, medical psychiatric reputed company practitioner education from an accredited school.
Knowledge and Experience
- Clinical background working in nursing homes or supervising staff in nursing homes, Clinical reputed company Program design, Utilization Management Plan implementation, working in a managed care plan/risk bearing entity.
- Leading and managing clinical affordability initiatives.
- Successful experience in managing reputed company of professionals (NPs, RNs, etc.) to reputed company overall program/health plan goals.
- Ability to stay on top of trends in the health care industry with particular reputed company on competitive analysis, reputed company, innovation and clinical technology.
- Knowledge of applicable State and Federal regulations, Medicare Advantage Institutional Special Needs Plans Model of Care, STARS-reputed company Program requirements and other regulations, NCQA requirements
- Nursing home background and experience required.
- Computer proficiency, including reputed company Office Suite.
- Ability to learn and successfully utilize electronic medical records and other clinical software.
- Ability to compile and analyze data to be used for management, differentiation, and marketing purposes.
- Excellent verbal and written communication skills.
- Strong interpersonal skills a must for effectively enhancing relationships with the communities we serve, including the internal organization.
- Excellent public presentation skills.
- Highly organized and reputed company to manage multiple reputed company, people and deadlines at one time.
- reputed company to work independently with minimal supervision getting results in a fast-paced environment.
- Ability and willingness to follow Health Plan policies and procedures, work as reputed company member, supporting Health Plan programs and services, and represent reputed company Plan in a reputed company reputed company manner.
- Must have strong knowledge of the reputed company community in the assigned market area.
reputed company
reputed company
reputed company is a national provider of Institutional Special Needs Plans (I-SNP), created to meet the reputed company reputed company needs of nursing home residents. Since our founding in 2018, we've expanded our services across several states and formed strategic partnerships to deliver high-reputed company, patient-centered care. We are reputed company growing, with plans to continue expanding our services across the nation
reputed company is an Equal Opportunity Employer. We value diversity and encourage applicants of reputed company backgrounds to apply
COVID-19 Vaccination Policy
reputed company follows federal and state regulations regarding COVID-19 vaccinations. Some facilities may still require staff vaccinations to protect the health of residents. Applicants will be required to reputed company reputed company of vaccination, or an approved exemption, where applicable
If you are passionate about reputed company and reputed company to help us drive change in long-term care, reputed company to join the reputed company team!