Director of Clinical Operations, ACO Reach

Location: Remote-US, California US

Notice

This position is no longer open.

Job Number: 4863

Workplace Type: Hybrid Remote

Position Title: Director, Clinical Operations

External Description:

Alignment Health Accountable Care Organization (ACO) is a group of clinicians and other health care providers brought together to provide coordinated care to Medicare beneficiaries.   As per the Centers for Medicare & Medicaid Services (CMS), the purpose of the model is to improve the quality of care for people with Medicare through better coordination and reaching and connecting health care providers with beneficiaries, including those who are underserved, a priority for achieving equitable outcomes through high quality, affordable, person-centered care.  As part of the Alignment Health team, your role will be primarily to support the ACO program and its assigned beneficiaries but may also include other Alignment Health clinical programs.

Alignment Health was founded with a mission to revolutionize health care with a serving heart culture. Through its unique integrated care delivery models, deep physician partnerships and use of proprietary technologies, Alignment is committed to transforming health care one person at a time. By becoming a part of the Alignment Health team, you will provide members with the quality of care they truly need and deserve. We believe that great work comes from people who are inspired to be their best.

 

Position Summary:

  • The Director of ACO Clinical Operations is the lead for all clinical administrative requirements of the ACO to include activities such as plans to serve the underserved population and implementation of all benefit enhancements (BEs) and beneficiary engagement incentives (BEIs).
  • The Director of ACO Clinical Operations will partner with ACO administrative leadership on all aspects of the ACO to include developing and implementing a strategy, key initiatives, and associated action plans, and key performance indicators (KPIs) to track ACO performance.
  • The Director of ACO Clinical Operations provides departmental direction and day-to-day operation of ACO Care Management programs to support Care Coordination, Complex Care Management and Social Services for our ACO population.
  • The Director of ACO Clinical Operations oversees the development and implementation of policies and procedures that support the ACO clinical goals and is responsible for monitoring health outcomes and trends.

 

 

General Duties/Responsibilities:

(May include but are not limited to)

  • Provides direction for the operations of Care Coordination, Case Management and Chronic Care Improvement.
  • Monitors and reviews key performance indicators (i.e., inpatient and SNF bed days, admissions and 30 days re-admissions) patient outreach data, and incoming call data and quality improvement projects related to the area of responsibility.
  • Develops clinical partnerships with Hospital Case Management and Hospitalist teams, and post-Acute partners such as Skilled Nursing Facilities, Hospice and Home Health Agencies. 
  • Develops, maintains, and operationalizes CMS approved BEs and BEIs, educating staff on requirements, overseeing compliance and outcomes tracking.
  • Develops relationships with vendors and attend monthly and quarterly meetings.
  • Develop and revise patient outreach strategy as necessary
  • Assist in meeting planning and presentation materials for provider town halls and practice manager meetings; attend and present relevant clinical information and performance metrics.
  • Develops and implements health equity plan to meet the needs of the underserved population.
  • Works closely with the company's VP of Quality on ACO Quality metrics.
  • Ensures program compliance requirements with the Center for Medicare and Medicaid Services (CMS) and all other State and Federal regulations are met.
  • Works with Regional Vice Presidents, Regional Medical Directors, Network, and Provider Relation Teams ensuring the best quality of clinical support.
  • Carries out all responsibilities in accordance with organization policies and applicable laws.
  • Responsibilities include interviewing, hiring and training Care Coordination staff; planning, assigning and directing work; appraising management staff performance; rewarding and disciplining employees; addressing escalated complaints and resolving problems.
  • Other duties as requested.

 

Supervisory Responsibilities:

This individual supervises the CM management staff, Social Workers and others, as assigned.

Responsibilities include recruiting, selecting, orienting, and training employees; assigning workload; planning, monitoring, and appraising job results; and coaching, counseling, and disciplining employees.

 

Minimum Requirements:

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily.  The requirements listed below are representative of the knowledge, skill, and/or ability required.  Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

 

  1. Minimum Experience:
    1. 5 years of clinical experience; or any combination of education and experience, which would provide an equivalent background.
    2. Health Plan/ACO experience or other experience designing, implementing, and managing clinical programs and outcomes which would provide an equivalent background.
  2. Education/Licensure:
    1. Current, Active and Unrestricted Registered Nursing license in the state in which you are applying; Certification preferred.
    2. Master’s degree in relevant field preferred
  3. Other:
    1. Leadership experience working in ACOs preferred
  4. Work Environment:
    1. The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job.  Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.


Essential Physical Functions:

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

 

  1. While performing the duties of this job, the employee is regularly required to talk or hear. The employee regularly is required to stand, walk, sit, use hand to finger, handle or feel objects, tools, or controls; and reach with hands and arms.
  2. The employee may lift and/or move up to 10 pounds. Specific vision abilities required by this job include close vision and the ability to adjust focus.

 

 

City: Remote-US

State: California

Location City: Remote-US

Location State: California

Community / Marketing Title: Director of Clinical Operations, ACO Reach

Company Profile:

By leveraging our world-class technology platform, innovative care delivery models, deep physician partnerships and our serving heart culture, Alignment Health is revolutionizing health care for seniors! From member experience professionals and clinicians, to data scientists and operations leaders, we have built a talented and passionate team that is deeply committed to our mission of transforming health care for the seniors we serve. Ready to join us?

At Alignment, delivering exceptional care to seniors starts with ensuring an exceptional experience for our over 1,300 employees. At the center of our employee experience is a culture where employees at all levels and across all teams are encouraged to share their unique ideas and perspectives. After all, when you can bring your authentic self to work, whether that’s in a clinical setting, our corporate office or a home office, creativity and innovation flourish! Another important part of the Alignment culture is a belief in continuous learning and growth. As a result, in this fast-growing company, you will find ample support to grow your skills and your career – with us.

EEO Employer Verbiage:

 

Please note: All clinical positions are contingent upon successful engagement with Alignment Health’s COVID-19 Vaccination program (fully vaccinated with documented proof or approved exception/deferral).

Alignment Health is an Equal Opportunity/Affirmative Action Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, age, protected veteran status, gender identity, or sexual orientation.

*DISCLAIMER: Please beware of recruitment phishing scams affecting Alignment Health and other employers where individuals receive fraudulent employment-related offers in exchange for money or other sensitive personal information. Please be advised that Alignment Health and its subsidiaries will never ask you for a credit card, send you a check, or ask you for any type of payment as part of consideration for employment with our company. If you feel that you have been the victim of a scam such as this, please report the incident to the Federal Trade Commission at https://reportfraud.ftc.gov/#/. If you would like to verify the legitimacy of an email sent by or on behalf of Alignment Health’s talent acquisition team, please email [email protected].