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Healthcare

EmblemHealth Hiring For AVP, Clinical Implementation at New York, NY  Full Time

Job Discription

AVP, Clinical Implementation

New York, New York

New

Summary of Position

  • Provide overall strategic, clinical, and operations management with direct accountability for all [(1) Medicare, DSNP and
    Commercial or (2) Medicaid, HARP, Essential Plan] lines of business.
  • Responsible for all clinical programming compliance requirements.
  • Responsible for the clinical partnership with various care management vendors impacting the care delivery.
  • Direct and lead large multidisciplinary clinical care management teams addressing a wide range of health concerns and
    inclusive of programs such as complex case management, transition of care, disease management and behavioral health care
    management.
  • Responsible for planning, organizing, and directing the administration of all Care Management Programs.
  • Develop and coordinates care management strategies for ensuring the delivery of care in the most appropriate setting.
  • Lead the implementation of improved clinical care management models and collaborations to decrease preventable
    admissions, and readmission.

    • Principal Accountabilities

  • Direct, plan and implement large, complex initiatives across a broad clinical team.
  • Set and execute successful clinical growth strategies.
  • Establish budgets and prepare/execute strategic plans.
  • Provide expert knowledge and thought to leadership to develop and manage all clinical programming.
  • Serve as point person for the launch of new programs based on company-wide goals or pilot projects.
  • Lead the clinical team in the planning, development, and implementation of clinical operations that deliver care that is
    timely, safe, effective, efficient, equitable, and in alignment EmblemHealth’s mission to provide for quality healthcare.
  • Accountable for delivering on contract and programmatic performance metrics across all payor classes (Public and
    Private) and clinical programs.
  • Oversee Quality Assurance/Performance Improvement activities across Medicare/State Sponsored/Commercial.
  • Work in close collaboration with compliance staff to ensure that clinical services, documentation, training, and
    supervision meet regulatory requirements.
  • Manage a team of staff at all levels, including the developing and implementation of Key Performance Indicators and
    Milestones for tracking productivity and performance.
  • Ensure employee compliance with training, supporting employee engagement efforts, and the ongoing professional
    development of individual employees.
  • Set the standard for providing timely and consistent feedback to promote positive behaviors and address areas of
    growth
  • Ensure that clinical services are delivered in accordance with recognized best practices with the continued
    development across modalities provided at EmblemHealth.
  • Provide operational oversight and support of all programs.
  • Continually assess, monitor, and improve policies, procedures, and systems as needed.
  • Ensure ongoing understanding of all policies, procedures, and regulatory changes and positively represents
    EmblemHealth to external stakeholders.
  • Take initiative on individualized projects set by leadership.
  • Perform under time constraints in a fast-paced environment with a high sense of urgency.
  • Develop and organize the creation and implementation of new curriculum to ensure process measures and outcomes
    are improving month over month.
  • Participate in external committees and conferences as required.
  • Participate in agency committees as appropriate.

    • Education, Training, Licenses, Certifications

  • Bachelor’s degree in Nursing
  • Master’s degree in nursing, clinical area, business administration, preferred

    • Relevant Work Experience, Knowledge, Skills, and Abilities

  • 10 – 12+ years of relevant, professional clinical operations experience. (R)
  • 5+ years of health plan care management experience. (R)
  • Strong operational, analytical, and leadership skills. (R)
  • Solid understanding of appropriate metrics, measures, and outcomes; ability to work in a data driven environment. (R)
  • Thorough understanding of medical information systems, medical claims payment processes, coding, provider contracting
    approaches, and case management practices. (R)
  • Ability to implement change in a consultative approach and maneuver in a matrix reporting environment. (R)
  • Experience managing staff, including hiring, training, managing workload and performance. (R)
  • Medical management experience. (R)
  • Strong understanding of managed care operations and change management. (R)
  • Detailed knowledge of New York and/or Connecticut regulations. (R)
  • Detailed knowledge of Federal regulations regarding care management services, as well as NCQA accreditation standards for
    care management. (R)

    • Additional Information

    • Requisition ID: (see application details)

     

    Job Overview

    • Date Posted:
    • Location:
    • Job Title: EmblemHealth Hiring For AVP, Clinical Implementation at New York, NY 
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