Executive Director of Clinical Solutions

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Job Type

Part-time

Description

Cameron Memorial Community Hospital is a 25-bed, independent, not-for-profit facility that proudly serves Angola and Steuben County. We have been a cornerstone of this community and the surrounding area in northeast Indiana dating back to 1926. Over the years, we have helped generation after generation of area residents enjoy better health and live comfortably. Today, Cameron Hospital has grown into something more than a simple community hospital. Filled with advanced equipment and skilled specialists, Cameron is a modern, high-tech facility that provides advanced diagnostics, a variety of specialties and cutting-edge treatment options that are combined with highly personalized and compassionate care.

DEPARTMENT: Administration

JOB TITLE: Executive Clinical Operations

SHIFT: PRN - Part-time, As needed

Summary/Objective

Under general direction of the Chief Financial Officer, responsible for the evaluation and review of financial, coding and documentation strategies as they relate to the population health program and other Payor Quality programs. This position will also lead project management activities and process improvement teams upon request.

Essential Functions

• Support the develop and implementation of programs that improve the health of the population served.
• Review, evaluate and make recommendations on payor contracts for opportunity as it relates to reimbursement and alignment with quality programs.
• Partner with operation leadership on the identification and implementation of coding goals related to chronic care management (CCM) and transitional care management (TCM).
• Collaborate with leadership to identify focus areas for CCM compliance and accuracy.
• Support leadership with strategies related to CPT II coding and Z-code capture as it relates to population health and quality initiatives.
• Evaluate HCC capture rate and assist leadership on identifying operational strategies and areas of focus.
• Partner with Coding and operational leadership to develop an ongoing HCC coding education and audit program.
• Use data to develop and implement effective strategies and care intervention designs to achieve Cameron’ performance goals related to health insurance alternative quality-based and/or risk-based contracts, including but not limited to accountable care organization programs and payor contracts.
• Review of insurance claims records to identify areas of improvement for reducing costs and improving efficiency.
• Identify gaps in care for patients with complex health needs to ensure they receive appropriate care and follow up from specialists or other providers.
• Prepares reports and presentations related to reviews completed.
• Assist in building and maintenance of dashboards that monitor performance and highlight improvement opportunities.
• Co-develop programs that lead to medical cost savings by using a data driven approach that allows patients to access equitable care.
• Partner with physicians and other members of the care team to promote quality and cost improvement initiatives.
• Work closely with IT, Finance, Quality, and operational teams to train and support providers and clinical staff on successful execution of programs.
• Evaluation and assessment of tools to aid in accurate documentation.
• Maintain knowledge of current and emergent population health strategies, models of care, and related trends.
• Develops tool kits, education, and reference materials and provide updates as needed to leadership.
• Lean and process improvement project support as needed.
• Project management upon request.
• Performs other duties as assigned.
  
  

Qualifications

Experience

• 5 years of experience in healthcare with 3 years in Population Health, Quality Assurance, Case Management, Nursing or related field
• Management experience preferred.
  
  

Skills/Competencies

• Excellent written and oral communication skills
• Ability to work independently and complete projects on time with minimal supervision.
• Ability to work with teams and individuals in a professional and friendly manner.
• Knowledge of complex hospital and healthcare systems, processes, and quality/performance improvement
• High level of professionalism and confidentiality.
• Ability to synthesize information from multiple sources to develop appropriate guidelines and policies.
• Detail oriented with strong organizational skills and ability to multitask.
• Knowledge of state/federal laws and references along with regulatory agency requirements
• Computer literate: must be able to demonstrate proficiency with MS Office Suite products as well as Electronic Medical Record programs and Event Reporting Software.
• Must have experience with research, statistics, analysis, and quality improvement concepts.
• Leadership skills
  
  

Requirements

Education

• Master’s Degree Required
  
  

Certifications

• Certification in Lean, or Project Management, or other Process Improvement