Commonwealth Care Alliance Hiring For Clinical Manager – MAPD – Massachusetts at Springfield, MA  Full Time

Why This Role is Important to Us

At Commonwealth Care Alliance (CCA), our vision is to lead the way in transforming the nation’s healthcare for individuals with the most significant needs. If being part of a team and working on combined solutions for patients matters to you…keep reading. We may have something to talk about.

This is a great opportunity to join the leadership team for our new MAPD plan in Massachusetts!

The Manager, Clinical Care Partnerships will play a vital role in the success of the entire Care Partnership organization at CCA. The main expectation of the Clinical Manager is to be accountable for the performance of the team, by ensuring that all key performance metrics are met as well as the team’s daily operations, including the member experience, care management, care coordination, and care delivery. The Clinical Manager will ensure that the team meets clinical and health plan related KPI’s (Key Performance Indicators) which are set by clinical leadership, regulators, and the business. Commonwealth Care Alliance’s (CCA) Care Partner Team is primarily responsible for providing longitudinal care coordination, care management, and care delivery to a dedicated panel of CCA members, a group of individuals with significant medical, behavioral, and social complexities.

As a keystone of the Clinical Group leadership team, the Manager, Clinical Care Partnerships participates in the development of tactics and is responsible for the execution of strategies to meet objectives. The Manager, CCP is engaged in the hiring and onboarding, performance management and staff enablement to support and improve care delivery, care management, and clinical operations in alignment with the strategic goals of CCA.

At CCA, your role matters. You’ll be joining an organization that is mission driven, believes in internal mobility, has excellent benefits (see below) and embraces innovation when it comes to serving our patients.

What We’re Looking For

• Associates Required or Diploma in Nursing or higher, Bachelors degree preferred
• RN, NP, PA with licensure in good standing in the state they are hired to work
• NP, PA strongly preferred
• 5 plus years of related clinical experience
• 2 plus years leadership experience preferred
• Fluency in English required; fluency in one or more of the following languages strongly preferred: Spanish, Portuguese, Russian, Nepalese, and Vietnamese.

• Experience with cross-functional collaboration for process improvement
• Strong management and team-building skills
• Ability to manage significant change
• Excellent communication skills
• In-depth knowledge of CCA resources, clinical guidelines, systems, and processes
• Ability to teach, mentor, and coach across disciplines
• Ability to quickly shift gears and move in a new direction without clear guidance

Does this sound like you? If you’re interested in this opportunity, please apply today. The process takes 10-15 minutes. We offer excellent benefits, including:

Medical, dental and vision plans with low employee contributions
A generous paid time off program
403(b) with company match
Loan Forgiveness Program
Educational Assistance/Reimbursement

keywords: manager, supervisor, leader, mentor, process improvement, kpi, clinical, RN, registered nurse, NP, nurse practitioner, PA, physician assistant, APC, advanced practice consultant, master’s degree, managed care, case management, Medicare Advantage, MAPD, Medicare, Medicaid, DSNP, special needs, bilingual, Massachusetts, MA, Springfield, Worcester, Boston

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What You’ll Be Doing

• Leads a team comprised of nurses, advanced practice clinicians, behavioral health clinicians and community health workers.
• Some team members may report to a discipline specific manager, with a matrix reporting to the Clinical Manager
• Holds team accountable to meet Key Performance Indicators, proactively identifies areas of opportunity and improvement for individual contributors, creates action/development plans for individual contributors and follows through on plans.
• Ensures that work is evenly distributed across the team, collaborates with other clinical managers to ensure even distribution across teams
• Accountable for quality and financial outcomes, service utilization, targeted case mix and productivity levels of Care Partners
• Collaborates closely with Behavioral Health leadership to ensure appropriate integration within the team
• Models collaboration with other CCA “specialties” including palliative care, women’s health, diabetes management, and the medical directors.
• Active participant in Medical Management initiatives, working toward CCA’s goal of impacting the cost of health care for the dual eligible population
• Is responsible for the Root Cause Analysis process within the team, reviewing all inpatient medical hospitalizations to identify areas of opportunity and improvement for individual contributors.
• Reviews service plans to ensure “right sizing” by identifying areas to impact financial outcomes.
• Depending on licensure level, may collaborate with Clinical Director on this process
• Participates in the selection, hiring, and onboarding of staff as well as performance appraisal.
• Addresses internal personnel issues, problem-solves local issues and engages in conflict management
• Provides clinical guidance and coaching for complex situations throughout the team.
• Acts as mentor and coach to new Clinical Managers
• Leads team meetings and selective (audit oriented) high risk case reviews)
• Lead re stratification discussion to ensure members are in the correct care model
• Provide oversight over new hire orientation in close collaboration with CCA’s Education Department
• Prepares and analyzes reports to manage patient care and team performance
• Reviews clinical documentation and records to ensure accuracy and timeliness
• Provides input to Clinical Director and senior leadership into strategies to improve the performance of CCA
• Works cross-functionally within the organization to overcome barriers to effective and efficient local work flows
• Participates in cross-organizational working groups to continuously improve practice
• Develops, refines, and enhances clinical programs, initiatives, processes, policies, workflows, and projects.
• Participates in CCA Quality Improvement efforts.
• Participates in committees and workgroups that promote clinical excellence and help to advance CCA’s mission and business objectives.
• Actively participates in the evaluation of own performance and progress.
• The Manager, Clinical Care Partnership directly manages an interprofessional team of Care Partners with matrixed reporting of advanced practice, behavioral health and HOW team members

Actual Work Location

101 Wason Avenue, Springfield, Massachusetts 01107

All Locations

CCA West – Wason Ave.; Worcester; Charlestown

Exempt / Not Exempt

Exempt