Market Director Of Clinical Services

Join us in transforming healthcare.

At Longevity Health, we're dedicated to advancing healthcare through innovation, compassion, and excellence. We're looking for passionate individuals to join our team and help us make a difference. The individual holding this position is required to support and demonstrate their commitment to Longevity Health’s purpose: To optimize the quality of life of people in long-term care by focusing on their individualized health needs.

Key Tasks and Responsibilities:

• Daily oversight and monitoring of the Model of Care elements/metrics, clinical performance metrics and quality metrics to ensure clinical program quality excellent and contract compliance.
• Primary authority and responsibility for managing the overall clinical operations and quality functions within the market. Facilitating HEDIS and STARs/MTM compliance, communication and ensuring gaps closure.
• Reviewing and disseminating the coding gaps, suspects and low prevalence reports and ensuring APPs are absorbing and closing as appropriate.
• Makes periodic facility rounds to ascertain relationship status, APP integration, PCP receptivity.
• Oversight authority for any delegated entities delivering LHP clinical services, clinical affordability program.
• Responsible for the overall clinical performance of the market- HEDIS/STARS rating, Admits/1000, Documentation and Coding accuracy, MTM reviews rate.
• Responsible for conducting nursing home readiness evaluations and making recommendations to the Market President/Vice President and Chief Clinical Officer for implementation in partnership with Network Manager.
• Supervises market clinical resources assigned based on market size and complexity such as the Clinical Implementation Manager, Clinical Field Operations Manager, RN Implementation Support Coordinator.
• Ensures clinical and quality programs are delivered in accordance with state and federal regulations, accreditation standards and health plan objectives. Create and ensure delivery of standards and policies within budgetary guidelines.
• Responsible for the delivery and review of the Annual Quality Improvement Plan, Utilization Management Plan, and affiliated policies, procedures, and staff/vendor training. Actively participates in Quality Improvement Committee Meeting and CCIP program. Drives market based and national quality improvement initiatives.
• Actively participates in Health Plan Clinical Ops, Quality, Delegated Oversight and other assigned Committees/meetings.
• Creates efficient and effective clinical workforce and local supporting clinical and operational processes.
• Responsible with the Account Manager/Market Leader to run the monthly facility meetings with Nursing Home leadership to ensure good working relationships with stakeholders to provide ongoing clinical reviews of hospitalizations and facility metrics and provide follow up interventions.
• Responsible for the oversight of the Clinical manager(s) and all APPs in the market will review performance metrics and APP scorecard and deliver CAP (in consult with COO).
• Conducts market-based Hospitalization Review Meetings collaboratively with market Medical Director, ensures follow-up actions in place, accuracy of the hospital tracking data.
• Actively participates in Utilization Management Meetings and reviews, Quality Investigations.
• Leads market clinical performance improvement programs/projects to improve clinical outcomes and develops risk mitigation plans when performance is not on track.
• Ensures effective nursing facility relationships that foster member growth and effective Medical Loss Ratio management.
• Engages market Medical Director in education and enhancement of clinician performance and PCP engagement.
• Accountable for market APP and APP Clinical Manager assimilation and retention.
• Leads innovation and special projects aimed at improving member outcomes.
• Develops and implements cost effective clinical staffing plans and training/support programs to ensure optimal market clinical performance.
• Identifies risks to effective clinical execution and implements plans to mitigate.
• Actively participates in marketing, budgeting, and forecast process.
• Actively participates in medical cost management initiatives.
• Effectively collaborates with Market Leader, Medical Director to engage partners, PCPs, and key stakeholders in achieving market targets.
• Creates an environment of efficiency, effectiveness and avoidance of unnecessary procedures, testing, that may be harmful or that does not improve quality of life for members.
• Where state mandated, ensures APPs have collaborative practice agreements in place and effective oversight monitoring is in place and being done.
• Performs other related duties as assigned.

Supervisory Responsibilities:

• Provides guidance, direction, and coaching of Clinical Managers, Clinical Coordinators, and other clinical personnel.
• Conducts orientation/building assimilation and performance management of Clinical Managers, Coordinators and Clinicians.
• Ensures contracted APPs are executing LHP APP functions through frequent audits, onsite meetings and surveys.
• Leads by example, fostering professional development of market clinicians.
• Accountable for effective staffing plans, clinician retention.

Credentials & Coverage:

• State unrestricted licensed Advanced Practice Nurse and National Board certification (AANP, ANCC or AACN) OR state unrestricted licensed Physician’s Assistant and NCCPA board certified required.
• DEA License required.
• Must have an active national provider number (NPI) and an active Medicare provider number.
• Valid state driver's license with a good driving record and proof of automobile insurance required.
• Auto insurance coverage as required by your state of residence. New employees will be responsible for providing proof of coverage prior to hire and on an ongoing basis.

Education and Training:

• Master of Science in Nursing as a Nurse Practitioner from a nationally accredited program OR Master’s Degree from a nationally accredited program.
• Adult, geriatric, family, acute care, primary care OR hospice and palliative, medical psychiatric nurse practitioner or Masters-level education from an accredited school.

Knowledge and Experience:

• Clinical background working in nursing homes or supervising staff in nursing homes, Clinical Quality Program design, Utilization Management Plan implementation, working in a managed care plan/risk bearing entity.
• Leading and managing clinical affordability initiatives.
• Successful experience in managing a team of professionals (APPs, RNs, etc.) to achieve overall program/health plan goals.
• Ability to stay on top of trends in the health care industry with particular focus on competitive analysis, growth, innovation and clinical technology.
• Knowledge of applicable State and Federal regulations, Medicare Advantage Institutional Special Needs Plans Model of Care, STARS-Quality Program requirements and other regulations, NCQA requirements
• Nursing home background and experience required.
• Computer proficiency, including Microsoft Office Suite.
• Ability to learn and successfully utilize electronic medical records and other clinical software.
• Ability to compile and analyze data to be used for management, differentiation, and marketing purposes.
• Excellent verbal and written communication skills.
• Strong interpersonal skills a must for effectively enhancing relationships with the communities we serve, including the internal organization.
• Excellent public presentation skills.
• Highly organized and able to manage multiple projects, people and deadlines at one time.
• Able to work independently with minimal supervision getting results in a fast-paced environment.
• Ability and willingness to follow Health Plan policies and procedures, work as a team member, supporting Health Plan programs and services, and represent Longevity Health Plan in a positive professional manner.
• Must have strong knowledge of the healthcare community in the assigned market area.

Company Overview

Longevity Health is a national provider of Institutional Special Needs Plans (I-SNP), created to meet the complex healthcare needs of nursing home residents. Since our founding in 2018, we've expanded our services across several states and formed strategic partnerships to deliver high-quality, patient-centered care. We are actively growing, with plans to continue expanding our services across the nation.

Longevity Health is an Equal Opportunity Employer. We value diversity and encourage applicants of all backgrounds to apply.

COVID-19 Vaccination Policy

Longevity Health follows federal and state regulations regarding COVID-19 vaccinations. Some facilities may still require staff vaccinations to protect the health of residents. Applicants will be required to provide proof of vaccination, or an approved exemption, where applicable.

If you are passionate about healthcare and ready to help us drive change in long-term care, apply now to join the Longevity Health team!