ACO Operations Director

About Wilmington Health

Since 1971, Wilmington Health has been committed to the care and health of our community in Wilmington as well as all of Southeastern North Carolina. Wilmington Health is structured as a multi-specialty medical practice with primary care providers integrated into the system. In this way, Wilmington Health is able to provide a comprehensive and coordinated approach to the care of all our patients. Wilmington Health is committed to using collaborative, evidence-based medicine in providing the highest quality of care to the patients we serve.

Purpose:

The ACO Operations Manager will provide day-to-day oversight to Wilmington Health’s client groups participating in the Accountable Care Organizations associated with Wilmington Health’s Management Services Organization (MSO), Block Ops. This position will facilitate and support program governance, operations and communication strategies for our MSO ACOs which includes the development and maintenance of project plans, quality initiatives, cost containment, and patient experience initiatives.

Essential Duties/Responsibilities:

• Maintains knowledge regarding ACO policies and procedures, governance structure and regulatory requirements through ongoing research and regular attendance at training webinars.
• Utilizes standard project management tools and principles to define and manage project scope, monitor timelines and deliverables, and communicate and identify pathways to resolve risks and barriers.
• Oversees and maintains effective communication with stakeholders using communication plans, status reports, dashboard and various media sources tailored to the audience.
• Effectively plans and facilitates meetings of varied participants using standard meeting management tools and techniques (e.g. agendas, meeting roles, ground rules, minutes, action item tracking) including support of meeting logistics for ACO Boards and committees.
• Leads process improvement, new workflow development, enhancement through support of and collaboration with practices to drive performance on contract quality and equity metrics.
• Works collaboratively with practices and providers to develop campaigns to address gaps in care, monitors patient and practice/provider compliance with campaigns and provide feedback and adjustment as needed to ensure success.
• Leads planning efforts to enable the Block Ops team to effectively achieve high performance in risk-based contract quality and equity metrics and ensure compliance with regulatory agencies.
• In collaboration with the WH ACO and analytics teams, develops comprehensive operation for clinical data acquisition, reporting, and workflow development in support of quality measure improvement.
• In collaboration with local leaders, informs the redesign of local workflows to drive performance in quality and equity metrics.

• The Compliance Officer will create, maintain, and audit the ACO’s Compliance Plan and provide regular reports to the Governing Body of the ACO
• Establish and maintain a method for employees or contractors of the ACO, its ACO Participant Provider and Preferred Providers, and other individuals or entities performing functions or services related to ACO Activities or Marketing Activities to anonymously report suspected problems
• Work with the Wilmington Health Compliance Officer to receive claims analysis to identify potential fraudulent behavior or program integrity risks, such as inappropriate reductions in care, effort to manipulate risk score or aligned populations, overutilization, and cost-shifting to other payers or populations.
• Audit chart, medical records, Implementation Plans and other data from the ACO, its ACO Participant Providers and its Preferred Providers.
• Cooperate with all CMS monitoring and oversight requests and activities.
• Ensure compliance with all applicable state licensure requirements regarding risk-bearing entities in each state in which the ACO operates.
• In a form and manner and by a deadline specified by CMS, the ACO shall submit to CMS documentation demonstrating its compliance with the requirement set forth in the Agreement.
• Ensure compliance with all plans submitted to CMS for benefit enhancements or waivers.
• Ensure that the ACO has appropriate procedures in place to ensure that ACO Participant Provider and Preferred Providers have access to the most up-to-date information regarding Beneficiary alignment to the ACO.

QUALIFICATIONS

Required:

3 years’ experience in healthcare, with value-based care models (CMS MSSP, ACO REACH, Commercial full or partial risk contracts).

Demonstrated understanding of healthcare clinic models, HEDIS measures, STAR ratings, documentation processes, and strategies to close gaps in care and support caring for high and rising risk patients with multiple chronic conditions.

Strong expertise with MS Excel, MS Teams, and PowerPoint.

Preferred:

5 years’ in healthcare operational management

Demonstrated understanding and experience with SQL queries and analytics, understanding of risk stratification models, and the ability to translated data-driven insights into clear clinical priorities and interventions.

Bachelor’s Degree in Healthcare or Business Administration

ADA Physical Demands:

Rarely (Less than .5 hrs/day) Occasionally (0.6 – 2.5 hrs/day) Frequently (2.6 – 5.5 hrs/day) Continuously (5.6 – 8.0 hrs/day)