Job: Mgr, PCMH Operations M3 18

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Description:
- Mgr, PCMH Operations M3 18 (1100705)

Job Description

Mgr, PCMH Operations M3 18- 1100705

Description (We are proud to be an EEO/AA employer M/F/D/V.)

Healthways, the leading provider of specialized, comprehensive solutions to help millions of people maintain or improve their health and well-being and, as a result, reduce overall costs is teaming with CareFirst, the largest health care insurer in the Mid-Atlantic region that serves nearly 3.4 million members, to launch a next generation innovation in health care, the Patient Centered Medical Home. CareFirst's Primary Care Medical Home (PCMH) program is built upon a foundation to enable members to obtain high-value health care services, at more affordable cost, over the long term. Core to this program is the idea costs are reduced when a high-risk member is directly engaged with high-quality care through a fully-informed and integrated care team, led by the member's Primary Care Physician (PCP). The PCP helps the member successfully manage his or her disease and/or chronic condition through a highly coordinated care plan. This will enable the PCP to better see and understand the downstream costs and quality implications of referrals, and to take a continuous interest through informed specialist selection and collaboration.

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Healthways is serving as a partner in this program through RN Local Care Coordinators (LCC's) who will equip each PCP with support needed to provide engaging, effective, cost-efficient and high-quality care to the highest risk health plan members. Our LCC's will work with each PCP and his or her target member population to ensure seamless coordination of care and documentation of each member's care. The physician plays a central role within the care management team; to ensure effective and efficient care management, the physician will utilize additional resources (i.e. the care team), and the LCC's are critical to accomplishing this.

POSITION SUMMARY:

Healthways is committed to working with CareFirst to create a unique and innovative approach to improving the quality of patient care in the development, launch and successful delivery of medical home programs for their member and PCP populations. The position of Operations Leader, PCMH (Patient Centered Medical Home) Operations is responsible for overseeing the start-up, growth and enhancement of the Patient Centered Medical Home program. The Operations Leader works strategically with the customer and all members of the PCMH team to drive creation and execution of the operational model. Reporting to the VP of Operations, this role works closely with the client and Healthways account management, and ensures superior execution of contract requirements while routinely participating in executive client and internal meetings The leader ensures operational performance goals related to the PCMH program are achieved.

RESPONSIBILITIES INCLUDE:

Business Leadership Activities

Serve as thought leader and strategic partner to customer in this start-up PCMH program.

Collaborate with Healthways Account Director and CareFirst senior leaders to develop strategies to proactively address & mitigate risks/barriers impacting the success of PCMH model

In collaboration with CareFirst, create and execute policies, procedures and needed work flows

Participate in discussions with CareFirst CEO and other senior leaders to develop and present performance information and provide program status.

In partnership with CareFirst, oversee the development of strong working relationships with primary care physicians to integrate the Medical Home program into their practices, contributing value to the primary care physician and their patients.

Work with CareFirst and LCC's to coordinate a systemic removal of barriers to care that patient may experience

Collaborates with the Medical Director, Account Team and CareFirst to monitor program delivery performance to ensure contractual requirements are being met.

Management Activities

Oversee and provide support to operations of PCMH program to ensure customer expectations are met or exceeded. Provide oversight to Healthways team to ensure consistency in service delivery to drive contract outcomes.

Accountable for achieving operational metrics and targets established in collaboration with CareFirst

Continually analyze operating results and key components relative to established objectives and metrics. Develop strategies and implement initiatives to achieve performance goals.

Develop communication and referral mechanisms to assure that there is seamless communication between the CareFirst program, the primary care practice and the Care Coordination Team.

In conjunction with CareFirst, develop clinical reports for use in primary care office records, facilitating physician support of patients in behavior change

Collaborates with CareFirst Regional Care Coordinators and LCC supervisors regarding Healthways LCC staff

Ultimately responsible for the RN LCC field work force expected to exceed 75 Colleagues who will work collaboratively with community based physicians.

Other duties as assigned

Qualifications

This position requires a self directed, self-motivated, committed individual with strong leadership skills, and excellent communication skills. The successful candidate will recognize, embrace and support the philosophy, mission, values and vision of Healthways. This key individual will be able to demonstrate these values with his/her leadership practices. Strong analytical, critical thinking and decision-making skills, along with considerable tact and diplomacy, are all extremely important.

To successfully lead this new business opportunity, this person will create the new and different. This includes breakthrough thought and processes from a leader who is creative, visionary, and can manage innovation. This leader will be adept at making complex decisions and managing diverse relationships in a matrix environment.

EXPERIENCE AND QUALIFICATIONS:

Credentials

Bachelor's degree required. An advanced business or clinical degree is preferred.

Previous physician practice management experience

Skills and Experience

7-10 years of leadership experience (i.e., coaching mentoring, staff development, participative leadership style, project management) and track record of leading a remote organization strongly preferred.

5+ years experience in a healthcare environment (acute care, home health, physician office management, managed care organization, provider relations, pharmaceutical sales).

A balance of strategic operational capabilities and successful account / customer relations experience with corresponding results

Able to lead in a rapidly changing environment and engender drive and team cooperation and enthusiasm

Demonstrates ability to be highly organized, multi-tasked capable, and proficient in problem solving skills

Innate ability to take initiative, set strategic priorities, take ownership of assigned projects and initiatives and drive for results

Project Management experience preferred.

A strong leadership presence, persuasive leader and high level of intellectual and emotional intelligence.

Demonstrated ability to work effectively with patients and providers and all levels of administrative and professional personnel.

Demonstrates proficiency with data analysis and ability to organize data in support of reporting needs.?

Demonstrates computer competencies to include word processing, spreadsheet, presentation preparation, and data base management. Demonstrated ability to learn customized computer application.

Has valid driver's license and driving record showing no restrictions that would impede ability to travel by automobile.

Travel Requirements

80 % (variable) within assigned region

About Healthways:

For three decades, Healthways has been dedicated to improving the human condition. Each year, we learn more and do more for the millions of individuals who count on us to make a difference in their health and well-being. Healthways is a global provider of solutions that help employers, health plans and government agencies enhance business performance and reduce healthcare costs. Our mission is to create a healthier world, one person at a time.

Here at Healthways as we continue to make the world a healthier place, we have also created an environment where people choose to do their best work. Our unique culture thrives on mission-driven individuals who exude a high sense of energy and passion in everything that they do. Collaboration and teamwork are an essential part of everyday life for Colleagues who trust and depend on one another to achieve the highest degree of collective success. We are an organization that strives to recruit the best and the brightest individuals who take pride in the statement "I work for Healthways."

Job
: Operations

Schedule
: Full-time

Shift
: Day Job

Primary Location
: MD-Columbia

Other Locations
: Tennessee

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