Senior Director, Complex Care

BMC Software•Boston, MA

13h•$130,000 - $188,500•Hybrid

About The Position

POSITION SUMMARY: The Senior Director Complex Care Management oversees the Complex Care Management program strategy, implementation and staff across the Boston Medical Center Health System's (BMCHS) Medicaid Accountable Care Organizations (ACO), which are partnerships between the WellSense health plan and eight provider systems across Massachusetts including the Greater Boston, Southeast MA, South Shore, North Shore, Lowell, and Springfield/Holyoke areas. The Complex Care Management program includes direct delivery of field-based care management across the ACOs’ hospitals, primary care clinics, and community health centers, as well as partnership and management of delegated care management arrangements within the network. In close partnership with other leaders within Population Health Services, the Sr. Director will be responsible for setting a strategic vision for Complex Care Management as a key part of the larger BMCHS care management continuum, and overseeing operations and outcomes of the program. He/she will develop and maintain oversight of outcomes and performance data, be responsible for adjusting program design and implementation to achieve program goals, and be accountable for helping to drive quality outcomes. Additionally, the Sr. Director will continue to innovate and build programs and collaborations that enhance BMCHS's complex care management programs by leading efforts to develop targeted initiatives that impact the highest cost patients, such as a homelessness programs, clinical specialty programs (i.e. End Stage Renal Disease, Sickle-Cell Disease, palliative care), and other community collaborations that strengthen connections across the continuum of care. The Sr. Director serves as the primary subject matter expert and technical liaison for health system partners and leaders related to the development and delivery of care management programs. The Sr. Director is also a key representative to EOHHS and governmental leaders in advocacy of care management. Position: Senior Director, Complex Care Department: Pop-Health Care Management Schedule: Full Time ESSENTIAL RESPONSIBILITIES / DUTIES: The Sr. Director will have the key responsibility for recruitment and retention of high-performing care management teams and will play a mission critical leadership role in interfacing with system leaders to support ACO retention and optimize integration of care management teams into Population Health strategy. Leadership within BMCHS: In partnership with health plan and hospital leaders, iterate the strategy of the Complex Care Management program to support system goal and population needs, and to ensure ongoing close coordination between care management programs Develop and nurture constructive partnerships with leaders across BMCHS, including Wellsense Health Plan, Boston Medical Center, the Faculty Practice Foundation, and leaders of joint venture ACO partners across Massachusetts; collaborate with provider leaders to iterate program adaptation to local practice and ACO needs as appropriate Represent BMCHS in care management related discussions with state and representative bodies Care Management Program Management Define key program elements for care management programs, including: patient selection criteria, care management workflows and processes, team role composition, staffing ratios, etc. Centrally manage and implement a standardized care management program meeting state regulations and quality standards, while understanding the nuances of local clinical site dynamics and partnering with local site leaders and existing local site programs to ensure program success Define methods for measuring program success and demonstrating program effectiveness in managing total cost of care; partner with Clinical Analytics leads to define data and reports needed to manage performance Contribute to the field of Complex Care through participation, leadership and advocacy in national forums and interorganizational partnerships Care Management team leadership: Hire, develop, and motivate Care Management Directors and Managers Define recruitment and retention strategy to attract top care management talent across Massachusetts Serve as key point person interfacing with ACO partner CM/PopHealth leadership to ensure integration of care management teams into primary care practices and hospitals Maintain open lines of communication with local site leaders In partnership with the CCM medical director and other CCM leaders, ensure the maintenance of a robust training and education curriculum for care management staff, and oversee a professional development strategy for staff across disciplines Metrics: Design programs and interventions targeted at key program outcomes, including: Reduction in ED and avoidable inpatient visits Decreased total medical expense Improved patient satisfaction Improved clinical outcomes Improved provider satisfaction Performance on contractual audits with state and regulatory agencies Other Duties Perform other duties as needed.

Requirements

RN or LICSW licensure preferred; other clinical specialties may be considered
Bachelor’s degree required
Master’s degree in a health related field
Licensure: Social work candidates must be independently licensed Nurse candidates must maintain RN or NP licensure
Significant experience in clinical operations in a hospital, health system, provider practice, and/or community health center environment required
Experience leading complex care management programs
Experience building and managing a large, field-based team
10+ years of healthcare experience, with 5-7 years of leadership experience, including leadership of managers or directors
Visionary, creative leader with ability to motivate staff and stakeholders
Ability to partner with a variety of clinical sites, including community health centers, community hospitals, and academic medical centers where care management programs are deployed.
Excellent interpersonal skills and ability to work collaboratively across organizations and stakeholders
Ability to attract and develop top talent at the Director, Manager and front-line level
Commitment to staffing and leadership that reflects the demographic and cultural experience of the population served
Excellent written and verbal communication
Strong clinical operational skills
Advanced analytic abilities, including ability to define gaps and opportunities for improved performance and translate performance insights into operational actions
Business planning skills; ability to write clear and effective business plans for new programs
Ability to adapt to changes in healthcare delivery at local and systems level
Strong organizational and time management skills
Ability to thrive in a hybrid work setting requiring independent management in a remote setting, and a commitment to work onsite and in the field when advantageous to do so

Nice To Haves

Demonstrated interest in serving a culturally and socio-economically diverse patient population, particularly those with complex medical and behavioral health conditions including chronic medical illness, serious mental illness, and substance use disorder.

Responsibilities

In partnership with health plan and hospital leaders, iterate the strategy of the Complex Care Management program to support system goal and population needs, and to ensure ongoing close coordination between care management programs
Develop and nurture constructive partnerships with leaders across BMCHS, including Wellsense Health Plan, Boston Medical Center, the Faculty Practice Foundation, and leaders of joint venture ACO partners across Massachusetts; collaborate with provider leaders to iterate program adaptation to local practice and ACO needs as appropriate
Represent BMCHS in care management related discussions with state and representative bodies
Define key program elements for care management programs, including: patient selection criteria, care management workflows and processes, team role composition, staffing ratios, etc.
Centrally manage and implement a standardized care management program meeting state regulations and quality standards, while understanding the nuances of local clinical site dynamics and partnering with local site leaders and existing local site programs to ensure program success
Define methods for measuring program success and demonstrating program effectiveness in managing total cost of care; partner with Clinical Analytics leads to define data and reports needed to manage performance
Contribute to the field of Complex Care through participation, leadership and advocacy in national forums and interorganizational partnerships
Hire, develop, and motivate Care Management Directors and Managers
Define recruitment and retention strategy to attract top care management talent across Massachusetts
Serve as key point person interfacing with ACO partner CM/PopHealth leadership to ensure integration of care management teams into primary care practices and hospitals
Maintain open lines of communication with local site leaders
In partnership with the CCM medical director and other CCM leaders, ensure the maintenance of a robust training and education curriculum for care management staff, and oversee a professional development strategy for staff across disciplines
Design programs and interventions targeted at key program outcomes, including: Reduction in ED and avoidable inpatient visits Decreased total medical expense Improved patient satisfaction Improved clinical outcomes Improved provider satisfaction Performance on contractual audits with state and regulatory agencies
Perform other duties as needed.