CHESS: Sr Director, Clinical Operations

Sr Director, Clinical Operations

Position Summary:

The Sr. Director of Clinical Operations is a key executive on the leadership team for CHESS Health Solutions. This position is accountable for performance, vision, and strategy for our care management and pharmacy services teams. The incumbent will be tasked with driving our virtual care management and pharmacy quality management resources to aid our provider systems while maintaining high performance in CHESS value-based contracts. The incumbent will also be accountable for building and publishing a roadmap to move new partners toward the end goal of downside risk. The Sr. Director of Clinical Operations will advise clinical team directors on the development of EBM, care plans, polices, practices, and systems to monitor and implement quality control standards and measurements while ensuring compliance with regulatory agencies’ standards and requirements. The Sr. Director of Clinical Operations is broadly responsible for ensuring that all patients within the extended Value Partner Network receive high quality care, are well cared for and kept safe.

Position Responsibilities:

• Knowledge of and experience with value business contracting and how team-based care contributes to quality measure performance, MLR, RAF and utilization trends.
• Knowledge of and experience with the clinical components of federal and commercial payer programs for value-based payment: Next Gen ACOs, MSSP, Medicare Advantage.
• Completes and submits annual employee performance reviews within the month they are due to Human Resources.
• Capable and proven leader of teams that are responsible for clinical quality improvement. Ensures staff compliance with service expectations by rounding, coaching, and executing corrective action.
• Meet regularly with direct reports to foster accountability in their roles and to encourage personal growth and development
• Tracks performance throughout CHESS contracts and advises CHESS clinical team leads and partner clinical teams on opportunities for improvement and potential threats to performance
• Works closely with the Transformation team, clinical analytics, and CMO as potential new CHESS value partners are assessed to ensure a seamless transfer to operations.
• Works closely with Director of Care Coordination to ensure that CHESS is supporting the most advanced clinical work in the field while ensuring that Care Coordination programs are of the highest quality.
• Works closely with Director of Pharmacy to ensure that CHESS staff are supporting the most advanced clinical work in the field while ensuring that Care Coordination programs are of the highest quality.
• Works closely with the Operations team and Value Managers to track trends and year-end performance in clinical utilization, clinical quality, and risk adjustment across the CHESS ACOs.
• Works closely with clinical and operations directors and CMO to identify opportunities, triage issues and formulate interventions to promote clinical and financial improvement across the ACOs.
• Works closely with the Sr. Director of Contract Operations and the Sr. Director of Value Based Contracts and Network management to establish and maintain relationships with physician leads with CHESS payer partners.
• Works closely with medical directors and physician champions across CHESS Value Partners and payers to drive performance improvement across the CHESS ACOs.
• Works closely with the Director of Risk Adjustment Coding to ensure that coding practices are maximally effective while fully complying with all documentation requirements.
• Works closely with the Director of Quality to ensure that quality measures are appropriately defined, tracked and contracted targets are achieved.
• Works closely with the Director of Transformation to provide support when peer to peer engagement, education, and support are requested.
• Works with the executive team to promote continual innovation in all aspects of value-based care including the development of "Level Three" innovations to continually stay relevant as a national leader in the 'Fee for Value' journey
• Work with the executive team to ensure an adequate staffing model for meeting value partner commitments.
• Serves as a role model for customer service and supports staff in this process.
• Administers policies and procedures in a consistent manner.
• Identifies, analyzes, and resolves work problems to assure quality service.
• Actively participates as a team member by supporting decisions, accepting change, managing conflict effectively, and valuing the contribution of others.
• Assist in the annual budget development process.
• Works in partnership with other Executive Team members
• Works in partnership with MedCost leadership to ensure coordination of activities.
• Meets budget targets
• Works with CHESS Board of Managers members and Board of Managers Sub-Committee leadership/members to lead and coordinate all required activities
  
  
  

Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. Duties, responsibilities, and activities may change at any time with or without notice.

Position Qualifications:

Required

• RN License or equivalent clinical qualification
• Minimum of 10 years' experience in healthcare, with at least 5 years in a senior leadership role
• Proven expertise in care coordination, clinical operations, or quality improvement, particularly within a value-based care environment
• Strong knowledge of healthcare regulations, clinical best practices, and value-based care models.
  
  
  

Skills, Knowledge, And Abilities

• Excellent oral and written communication skills
• Ability to engage in public speaking.
• Knowledge of computer systems and applications
• Ability to develop and foster interpersonal relationships conducive to helping culture change
• Ability to be a team player in a multidisciplinary environment.
• Ability to demonstrate a value of all contributions to product and outcome
• Ability to evaluate the work of others and deliver feedback in a way that is acceptable and actionable.
• Ability to supervise, evaluate, coach and develop staff
  
  
  

MedCost provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws. This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation and training.

MedCost participates in the Electronic Verification system (E-Verify) to electronically verify the work authorization of newly-hired employees. E-Verify is an internet-based program that compares information from an employee's Form I-9 to data contained in the federal records of the Social Security Administration and the Department of Homeland Security to confirm employment eligibility. MedCost does not use E-Verify to pre-screen job applicants.