The ConcertoCare Director of Clinical Care develops and implements organization-wide and market-specific medical expense initiatives as a collaborative effort in partnership with Medical Directors, Population Health leaders, and our local market frontline care teams. Our DCCs support rising risk and high-risk patients through engagement and care delivery interventions to prevent unnecessary ER visits and hospitalizations in real-time and lead our market high-risk huddles to proactively address drivers of utilization and improve clinical outcomes. S/he partners with our finance and analytics team members to develop and interpret clinical analytics and real-time data dashboards and deep dive analyses that allow for proactive strategies to manage avoidable medical expenditures and reactive deep dive investigations to understand opportunities for clinical outcomes optimization.
This is an ideal position for a clinician who seeks an opportunity for “top of license” practice, enjoys a collaborative team-based approach to care, and is excited to engage in developing and nurturing our innovative, value-based clinical model focused on caring for patients with complex needs who are inadequately served by traditional healthcare delivery systems. While the primary focus of the role is on population management and medical expense performance, this role also provides patient care opportunities as part of our market clinical care team.
This position also affords professional development via dedicated clinical education programming and real-time support from our on-staff world-class experts in geriatric medicine, palliative care, geriatric psychiatry, clinical pharmacy, care management, and social determinants of health and health equity. The position reports directly to the Vice President of Case Management and Medical Expense performance and a dotted line to the market Medical Director, and is a key leadership role in both the market and the population health teams.
Responsibilities:
- Oversee and manage clinical utilization outcomes and KPIs; providing clear, active direction to the team to achieve specific goals and targets in collaboration with the Medical Director.
- Employ data and effective clinical tools to identify areas of utilization risk for the market and individual patients and assist the team in effective planning and management.
- Identify and target high-risk patients in need of clinical attention to address chronic and acute illness presentations within the practice.
- Be a liaison between acute, subacute, and skilled care institutions and clinical teams for patients with an acute presentation; proactively intervening to advocate for the lowest level of care clinically appropriate and a plan of care aligned with the patient’s goals of care.
- Facilitate multi-disciplinary high-risk huddles and other meetings addressing utilization and needs of the highest-risk patients.
- Utilize tools, programs, and strategies to identify areas of high-cost utilization, and work with practice leadership to address opportunities for improvement.
- Collaborate with other providers in facility settings to evaluate patient needs, guide care, manage, and coordinate transitions to appropriate levels of care.
- Provide direct patient care such as visits to avoid emergency room admissions, or post-discharge follow-ups, either in the patient’s home setting or through telehealth.
- Collaborate with Medical Directors, Population Health leaders, and other DCCs on initiatives and tools to impact utilization for high-risk, high-cost patients.
- Support training of providers and other staff in the care of high-risk patients and the processes and workflows of the DCC.
- Collaborate with Medical Director to articulate market utilization management annual goals and implement measures and interventions to help accomplish them.
- Participates and plays a leadership role in the organizational DCC collaboration and Medical Expense Review processes and meetings
- Participation in the after-hours on-call schedule as required.
- Other organizational and/or market-specific duties as assigned.
Qualifications:
- Nurse Practitioner or Physician Assistant with graduation from an accredited health professions school and successful completion of national board certification.
- 3+ years of experience in clinical practice as a provider preferred.
- Active clinical licensure in applicable state(s).
- Active DEA licensure and state-specific controlled substance registration, as applicable.
- Advanced training in geriatrics and/or palliative medicine preferred.
- Certification in basic life support (BLS) required.
- Clinical experience caring for aging adults and adults with complex care needs required.
- Clinical experience caring for patients in the home setting including private homes and/or congregate living facilities preferred.
- Previous experience with managed care and/or value-based healthcare delivery required.
- Working knowledge and experience with healthcare financing models such as Medicare, Medicaid, SNP, PACE strongly preferred.
- Demonstrated success working in matrixed organizations, and leading through both direct and indirect reporting models
- Demonstrated success with both leadership and “roll up your sleeves” roles
- Clearly demonstrated oral and written communication, facilitation, data analysis, and interpretation skills.
- Experience working with Medical Claims or other utilization data to identify clinical improvement opportunities highly preferred
- Average to advanced data analytics and average to advanced computer and software skills required.
- Ability and means to travel as needed in a timely manner to locations that may have limited access to public transportation; proof of liability and property damage insurance on vehicle used is required. DRIVER REQUIREMENTS: Licensed for a minimum of 5 years. No vehicle-related suspensions/reinstatements, DUI, reckless driving, or felony convictions within the last 7 years. Multiple violations and accidents within the last 5 years would be subject to review.
Base Salary/ Wage Range $150,000 and $160,000 plus annual bonus. Compensation for the role is commensurate with the candidate’s qualifications, skills, competencies, and experience and may fall outside of the range shown. ConcertoCare offers a competitive total rewards package, which includes full healthcare coverage, a 401K with match, and a broad range of other health, wellness, and financial benefits.
ConcertoCare requires all “frontline workers” to be fully vaccinated and to provide records for validation. Medical or religious exemption will be considered contingent upon the review of appropriate documentation.
We are an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or veteran status. ConcertoCare is an Alcohol/Drug/Smoke-Free Workplace.
