Senior Director, Complex Care

POSITION SUMMARY :

The Senior Director Complex Care Management oversees the Complex Care Management program strategy, implementation and staff across the Boston Medical Center Health System's (BMCHS) Medicaid Accountable Care Organizations (ACO), which are partnerships between the WellSense health plan and eight provider systems across Massachusetts including the Greater Boston, Southeast MA, South Shore, North Shore, Lowell, and Springfield/Holyoke areas. The Complex Care Management program includes direct delivery of field-based care management across the ACOs’ hospitals, primary care clinics, and community health centers, as well as partnership and management of delegated care management arrangements within the network.

In close partnership with other leaders within Population Health Services, the Sr. Director will be responsible for setting a strategic vision for Complex Care Management as a key part of the larger BMCHS care management continuum, and overseeing operations and outcomes of the program. They will develop and maintain oversight of outcomes and performance data, be responsible for adjusting program design and implementation to achieve program goals, and be accountable for helping to drive quality outcomes. Additionally, the Sr. Director will continue to innovate and build programs and collaborations that enhance BMCHS's complex care management programs by leading efforts to develop targeted initiatives that impact the highest cost patients, such as a homelessness programs, clinical specialty programs (i.e. End Stage Renal Disease, Sickle-Cell Disease, palliative care), and other community collaborations that strengthen connections across the continuum of care. The Sr. Director serves as the primary subject matter expert and technical liaison for health system partners and leaders related to the development and delivery of care management programs. The Sr. Director is also a key representative to EOHHS and governmental leaders in advocacy of care management.

Position: Senior Director, Complex Care

Department: Pop-Health Care Management

Schedule: Full Time

ESSENTIAL RESPONSIBILITIES / DUTIES:

The Sr. Director will have the key responsibility for recruitment and retention of high-performing care management teams and will play a mission critical leadership role in interfacing with system leaders to support ACO retention and optimize integration of care management teams into Population Health strategy.

Leadership within BMCHS:

• In partnership with health plan and hospital leaders, iterate the strategy of the Complex Care Management program to support system goal and population needs, and to ensure ongoing close coordination between care management programs

• Develop and nurture constructive partnerships with leaders across BMCHS, including Wellsense Health Plan, Boston Medical Center, the Faculty Practice Foundation, and leaders of joint venture ACO partners across Massachusetts; collaborate with provider leaders to iterate program adaptation to local practice and ACO needs as appropriate

• Represent BMCHS in care management related discussions with state and representative bodies

Care Management Program Management

• Define key program elements for care management programs, including: patient selection criteria, care management workflows and processes, team role composition, staffing ratios, etc.

• Centrally manage and implement a standardized care management program meeting state regulations and quality standards, while understanding the nuances of local clinical site dynamics and partnering with local site leaders and existing local site programs to ensure program success

• Define methods for measuring program success and demonstrating program effectiveness in managing total cost of care; partner with Clinical Analytics leads to define data and reports needed to manage performance

• Contribute to the field of Complex Care through participation, leadership and advocacy in national forums and interorganizational partnerships

Care Management team leadership:

• Hire, develop, and motivate Care Management Directors and Managers

• Define recruitment and retention strategy to attract top care management talent across Massachusetts

• Serve as key point person interfacing with ACO partner CM/PopHealth leadership to ensure integration of care management teams into primary care practices and hospitals

• Maintain open lines of communication with local site leaders

• In partnership with the CCM medical director and other CCM leaders, ensure the maintenance of a robust training and education curriculum for care management staff, and oversee a professional development strategy for staff across disciplines

Metrics:

Design programs and interventions targeted at key program outcomes, including:

• Reduction in ED and avoidable inpatient visits

• Decreased total medical expense

• Improved patient satisfaction

• Improved clinical outcomes

• Improved provider satisfaction

• Performance on contractual audits with state and regulatory agencies

Other Duties

JOB REQUIREMENTS

EDUCATION

• RN or LICSW licensure preferred; other clinical specialties may be considered

• Bachelor’s degree required

• Master’s degree in a health related field

CERTIFICATES, LICENSES AND CERTIFICATION

Licensure:

• Social work candidates must be independently licensed

• Nurse candidates must maintain RN or NP licensure

Certification

Preferred qualifications:

• Demonstrated interest in serving a culturally and socio-economically diverse patient population, particularly those with complex medical and behavioral health conditions including chronic medical illness, serious mental illness, and substance use disorder.

EXPERIENCE

• Significant experience in clinical operations in a hospital, health system, provider practice, and/or community health center environment required

• Experience leading complex care management programs

• Experience building and managing a large, field-based team

• 10+ years of healthcare experience, with 5-7 years of leadership experience, including leadership of managers or directors

KNOWLEDGE, SKILLS AND ABILITIES

• Visionary, creative leader with ability to motivate staff and stakeholders

• Ability to partner with a variety of clinical sites, including community health centers, community hospitals, and academic medical centers where care management programs are deployed.

• Excellent interpersonal skills and ability to work collaboratively across organizations and stakeholders

• Ability to attract and develop top talent at the Director, Manager and front-line level

• Commitment to staffing and leadership that reflects the demographic and cultural experience of the population served

• Excellent written and verbal communication

• Strong clinical operational skills

• Advanced analytic abilities, including ability to define gaps and opportunities for improved performance and translate performance insights into operational actions

• Business planning skills; ability to write clear and effective business plans for new programs

• Ability to adapt to changes in healthcare delivery at local and systems level

• Strong organizational and time management skills

• Ability to thrive in a hybrid work setting requiring independent management in a remote setting, and a commitment to work onsite and in the field when advantageous to do so

Compensation Range:

This range offers an estimate based on the minimum job qualifications. However, our approach to determining base pay is comprehensive, and a broad range of factors is considered when making an offer. This includes education, experience, skills, and certifications/licensures as they directly relate to position requirements; as well as business/organizational needs, internal equity, and market-competitiveness. In addition, BMCHS offers generous total compensation that includes, but is not limited to, benefits (medical, dental, vision, pharmacy), discretionary annual bonuses and merit increases, Flexible Spending Accounts, 403(b) savings matches, paid time off, career advancement opportunities, and resources to support employee and family well-being.

NOTE : This range is based on Boston-area data, and is subject to modification based on geographic location.

Equal Opportunity Employer/Disabled/Veterans

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