What are the responsibilities and job description for the Director ICT Care Coordination Population Health position at AmeriHealth Caritas?
Responsibilities
- Develop and maintain a collaborative working relationship with the CMO, informing the Population Health goals and strategy.
- Partner with the Population Health Director to ensure the Population Health goals and strategy are successfully executed and monitored.
- In collaboration with the CMO, Population Health Market Directors, and Quality Director, engage in continuous quality and process improvement activities on existing care coordination programs and new initiatives.
- Overseeing, executing, and managing market-specific clinical programs, including UM, CM, RROT, and Bright Start.
- Assure compliance of program execution with population health strategy and alignment with enterprise policies and contracts.
- Supervise market-specific Care Coordination- Integrated Care Clinical Operations staff and facilitate growth and professional development of the case / coordination team. Planned and maintained appropriate staffing levels; assisted in interviews to select qualified candidates.
- Responsible for market-specific contract and accreditation compliance related to Care Coordination -Population Health Clinical Operations and oversight of the ODM contract 42 CFR 438.208 to include but not limited to : Implement mechanisms for identifying, assessing, and developing treatment plans for members with special health care needs.
- Ensure access to primary care, behavioral health, and coordination of care services for all members.
- Serve as an MCO's primary point of contact for the State regulatory agencies on care coordination and similar functions.
- Develop and implement processes and resources for supporting members who opt out of care coordination.
- Coordinate services furnished to the member with the services the member received from any other health care entity, and;
- Ensure care coordination and disease management are part of the population health and QI activities when appropriate.
- Accountable for implementing effective and continuous programs to measure, assess, and improve health outcomes and performance.
- Monitor activities related to transition of care and care coordination quality improvement.
- Monitor LOB performance metrics and ensure appropriate action is taken to address performance opportunities consistent with state-mandated requirements and enterprise policies.
- Monitor LOB performance metrics and ensure appropriate action is taken to address performance opportunities consistent with enterprise policies.
- Serve as liaison with enterprise, sharing goals and objectives of LOB / Market and seeking to share best practices to and from the market to the enterprise.
- Direct communication with State and other county primary contractors concerning clinical services, policies, and performance in collaboration with Program Managers.
- Prepare meeting materials, monthly Market CM KPI reports, communications, planning, coordinating, and keeping the meeting contents focused.
- Collaborate with Market and Corporate Regulatory, EQRO, NCQA, and QAPI.
- Coordinate with the management team to provide detailed and accurate reports on Care Coordination utilization, service delivery, and member treatment.
- Lead SME for Procurement focused on Care Coordination / Care Management (RFP / RFI) and consult Population Health Growth for new markets.
Education / Experience :
3 to 5 years of experience :
Minimum of 5 years experience :
Diversity, Equity, and Inclusion
At AmeriHealth Caritas, everyone can feel valued, supported, and comfortable to be themselves. Our commitment to equity means that all associates have a fair opportunity to achieve their full potential. We implement these principles daily by acting with integrity and respect. We stand together to speak out against injustice and to break down barriers to support a more inclusive and equitable workplace. Celebrating and embracing the diverse thoughts and perspectives that make up our workforce means our company is more vibrant, innovative, and better able to support the people and communities we serve.
We keep our associates happy so they can focus on keeping our members healthy.
Our Comprehensive Benefits Package
Flexible work solutions include remote options, hybrid work schedules, competitive pay, paid time off, holidays and volunteer events, health insurance coverage for you and your dependents on Day 1, 401(k) tuition reimbursement, and more.
Generous paid time off and paid volunteer time off.
Employer-matched 401(k) and additional non-elective contributions, starting on day one.
Medical, dental, and vision plans — with coverage starting on day one.
Employee assistance programs, fitness reimbursements, nutrition counseling, and more.
Employer-paid life insurance, with opportunities to purchase additional coverage.
Employer-paid short-term disability coverage and long-term disability coverage.
Tuition assistance, including reduced tuition at certain schools.
Financial assistance with adoption, including paid time off.
Flexible spending and health savings accounts to pay for qualified expenses.
Discount programs on entertainment, travel, and more.
