9901 - Signature Advantage
9901 – Signature Advantage
Louisville, KY, US, 40299
Vice President of Clinical Services Operations
Signature HealthCARE is a family-based healthcare company that offers integrated services in 10 states across the continuum of care: skilled nursing, rehabilitation, assisted living, memory care, home health, cognitive care, and telemedicine.
A growing number of our centers are earning quality assurance accreditation and pioneering person – directed care. Many of our skilled nursing facilities have achieved a 4 or 5-star overall rating from the Centers for Medicare & Medicaid Services. Additionally, we have been awarded as a certified Great Place to Work for three years in a row and Modern Healthcare’s “Best Places to Work!”
How you will make a difference
- Oversee and work with health plan members, providers and a multidisciplinary team members to assess, facilitate, plan and coordinate an integrated delivery of care across the continuum, including behavioral health, pharmacy services and long term care, for members with high need potential.
- Responsible for coordinating with appropriate personnel and entities to meet operational program needs, ensures compliance with state / federal health plan requirements, Medicare guidelines, HEDIS / STARS, CMS and health plan requirements.
How you will spend your time
- Meet the physical and sensory requirements stated below and be able to work in the described environment.
- Identify and participate in process improvement initiatives that improve the customer experience, enhance work flow, and/or improve the work environment.
- Responsible for quality performance improvement activities identifying areas of opportunity and coordinating and implementing on such opportunities in conjunction with clinical teams.
- Management duties including, but not limited to, hiring, training and developing, coaching and counseling, and terminating department staff, as deemed necessary.
- Ensure that all employment practices are administered fairly and without regard to race, color, religion, gender, sexual orientation, national origin, age, disability, marital status, amnesty, or veteran status in accordance with applicable federal, state and local laws.
- Work closely and collaboratively with Signature Advantage Executives, Market leadership, delegated entities, and the rest of regional leadership to achieve the goals and objectives of the Utilization Management (UM) and Quality Management/Model of Care (MOC) programs.
- Ensure that patients progress toward desired outcomes with quality care that is medically appropriate and cost-effective based on the severity of illness and the site of service.
- Facilitate and serve on Clinical and Quality Committees designed to provide strategic direction for Signature Advantage Plan(s); and responsible for planning, organizing, and directing the administration of all Quality Programs.
- Oversees end-to-end strategy deployment and monitoring of all UM and quality program activities.
- Functions as a subject matter expert and provides leadership and support in establishing and directing the UM and Quality/MOC Programs.
- Partners with the Plan’s Medical Director to monitor health plan’s quality outcomes and creates strategies for improvement.
- Creates in support of UM/Quality Committee(s) with the development of the QM and UM Work Plan, Evaluation, and the monitoring of Work Plan activities as they relate to clinical Performance Improvement.
- Directs and oversees key Clinical Services functions: Case management/disease management/care transitions; utilization management; long-term supports and services; and/or nurse advice line.
- Develops, implements and/or monitors standardized protocols for clinical and non-clinical team activities to facilitate integrated proactive care review and management.
- Develop HEDIS / STAR member and provider engagement strategies to improve HEDIS, CAHPS, and HOS outcomes.
- Oversee HEDIS data submission process and lead, when applicable, accreditation efforts defined by SA.
- Promotes interdepartmental integration and collaboration to enhance clinical services, as well as understanding, communication, and coordination of all quality improvement program components.
- Collaborates with and keeps Executive leadership informed of operational issues, staffing, resources, system and program needs and presents solution action plan for issues.
- Facilitates and participates in committees, task forces, work groups and multidisciplinary teams as needed to promote standardized organization wide approach to Care Management programs.
- Ensures monthly auditing is occurring with appropriate follow-up.
- Creates or maintains policies/procedures that support corporate initiatives for meeting state and federal requirements and standards.
- Maintains knowledge of regulatory requirements associated with UM and Quality/MOC programs.
- Ensures and/or facilitates clinical training activities and outcomes.
- Maintains QI program documents, reports, and committee minutes and follow all internal privacy and confidentiality policies and procedures.
- Develop and mentor managers and supervisors.
- Develop operating budget as necessary and participate on various teams, committees, and meetings at any level required to maintain business necessity.
- Manages direct reports with expectations to grow the team over time.
- Direct medical / nursing / clinical best practice identification and standardization adoption in clinical settings with cross-functional teams and senior leaders.
- Build a more durable, integrated, unified Quality structure that will outlive any one individual’s tenure.
- Other special projects and duties, as assigned.
The qualifications you will need
- Bachelor’s Degree in Healthcare-related field, equivalent experience and/or Nursing license will be considered in lieu of Bachelor’s Degree.
- Master’s degree in Healthcare or Business Administration, preferred.
- Active and unrestricted multi-state license to practice in any state with the ability to obtain a Kentucky license within twelve (12) months of starting employment, preferred.
- Utilization Management Certification (CPHM) Certified Professional in Health Care Quality (CPHQ), or other healthcare or management certification, preferred.
- Demonstrated knowledge of the Medicare business environment and business requirements (e.g., strategy changes, regulatory and emerging business needs).
- Operational and process improvement experience, preferred.
- Experience working within applicable state, federal, and third-party regulations.
- Ten (10) or more years of managed care and/or senior management experience; ability to manage up, laterally, and within non-traditional matrixed structures by influence, preferred.
- Extensive experience with quality improvement standards: NCQA, HEDIS, CAHPS, HOS, CMS.
- Minimum of seven (7) years Medicare Advantage healthcare experience with line management responsibility including clinical operations.
- Must have medical claims experience and familiarity with Medicare productions.
- Ability to make timely decisions with appropriate information and consultation.
- High level of verbal and written communication skills with a strong capacity for detail, maintaining clear/effective contact with physicians, employees, administration and corporate personnel.
- Strong organizational and planning skills to manage multiple priorities and meet required deadlines.
- Management skills necessary to attract and maintain a highly effective and motivated staff.
- Proven ability to work independently to produce accurate work of the highest quality.
- Demonstrated intermediate to advanced skills in Microsoft Word, Excel, Power Point and Outlook, Internet and Intranet navigation.
- Highest level of professionalism with the ability to maintain confidentiality.
- Ability to communicate at all levels of organization and work well within a team environment in support of company objectives.
- Customer service oriented with the ability to work well under pressure.
- Ability to work with minimal supervision, take initiative and make independent decisions.
- Ability to deal with new tasks without the benefit of written procedures.
- Approachable, flexible and adaptable to change.
- Function independently, and have flexibility, personal integrity, and the ability to work effectively with stakeholders and vendors.
Signature HealthCARE is an Equal Opportunity-Affirmative Action Employer – Minority / Female / Disability / Veteran and other protected categories.