Job Title: PCMH Regional Care Director
Location: Washington, DC
Career Band: Band C
Job Posting ID#: 8769
This position supports the Arlington, Alexandria & Annandale VA area – Region 15.
The PCMH Regional Care Director is responsible for leading and overseeing all aspects of the Patient-Centered Medical Home (PCMH) program within a specific geographic region of which they are familiar, as follows:
Building relationships with practitioners and panels, and champions the PCMH concept in all PCMH practices/panels within their designated region. Serves as the Subject Matter Expert on PCMH in the field, and is responsible for practitioner and panel comprehension and adoption of PCMH/ Total Care and Cost Improvement (TCCI) core concepts.
Overseeing population health management and subsequent bending of healthcare cost curve for their Region using all aspects of TCCI.
Overseeing the Care Planning process and care coordination ensuring clinical quality.
Providing effective leadership of multi-faceted team and participates as a member of management providing thought leadership and contributing to overall business development and execution.
As part of the Total Care and Cost Improvement (TCCI), the PCMH Regional Care Director leads team of Local Care Coordinators, Program Consultants(s) and Physician Advisor to effectively engage PCMH Primary Care Providers (PCPs) to improve overall population health and stability, and decrease the healthcare cost curve. The incumbent ensures that practitioners enrolled in the Patient-Centered Medical Home Program (PCMH) become active participants in managing their patient population through risk stratification, appropriate planning and allocation of resources to meet the patients’ needs.
PRINCIPAL ACCOUNTABILITIES: Under the general direction of a Senior Director Regional Care Coordination, the incumbent’s accountabilities include, but are not limited to, the following:
Builds relationships with practitioners and panels, and champions the PCMH concept within all PCMH practices (panels) within a designated region. Serves as the Subject Matter Expert on PCMH in the field, and is responsible for practitioner and panel comprehension and adoption of PCMH/TCCI core concepts.
• Serves as the initial representative to introduce the PCMH Program details to enrolled practitioners; works to confirm Primary Care Physician (PCP) buy-in and agreement to work with Local Care Coordinators (LCC) to collaborate in managing their patients.
• Acts as Subject Matter Expert in the CareFirst PCMH program and leads regional team to educate and inspire panels of PCPs and their staff to assist in their achievement of self-sufficiency in operational aspects of the program.
• Builds and maintains a solid professional relationship with all assigned PCMH offices and is proficient and knowledgeable about the PCMH model. Communicates regularly with the PCMH Sr. Leadership on the operational issues/concerns and barriers identified from the field work with practices.
• Communicates to practices any program updates/changes as they occur and works with delegate to improve identified deficiencies, and prioritize opportunities.
• Partners with other CareFirst departments, including Networks Management, to maximize PCP engagement and program participation.
• Continuously assesses the engagement status of PCPs and panels in an effort to influence those who fully understand the program to more fully leverage all aspects of the program to impact quality outcomes and cost savings, and to ensure that those providers and panels not making any effort are discharged from further participation in the program.
Oversees population health management and subsequent bending of healthcare cost curve for their Region using all aspects of TCCI. Develops regional business plan considering programmatic goals and current state of performance, and establishes a roadmap for success related to the alignment of people, processes, and technology.
• Proactively guides PCPs regarding which specialists, facilities, and resources are designated cost-efficient and encourage PCP to weigh with quality outcomes.
• Maximizes the role of the Program Consultant and Physician Advisor for PCP education and awareness of opportunities to improve quality and decrease the cost curve. Identifies strategic and tactical levers and resources in an effort to influence and support a panels to design and implement practice transformation activities.
• Understands SearchLight resources and leads the Program Consultant(s) ensuring that they are utilizing these resources to engage PCPs and meet overall goals of decreasing the cost curve.
Oversees the Care Planning process and care coordination ensuring clinical quality.
• Works with PCPs and LCCs to identify appropriate patients. Responsible for the quality of care coordination for the region; coaching LCC to success with care plan development and care coordination to ensure the plans are of high quality to meet patients’ needs.
• Monitors quality and quantity of care plans for each LCC to include use of other TCCI programs as clinically appropriate.
• Effectively uses metrics to drive performance and achieve productivity goals for the region.
Provides effective leadership of a multi-faceted team and participates as a member of management providing thought leadership and contributing to overall business development and execution.
• Continuously monitors and evaluates staffing and distribution of LCC and Program Consultant resources across the Region to meet program and divisional goals.
• Leads team of LCCs in partnership with Healthways HR team to ensure LCC training, engagement and performance expectations are clearly understood and accomplished. Responsible for the direct management and development of CareFirst Program Consultant(s), with the goals of developing and retaining talent within the organization.
• Evaluates performance of each team member, generates development plans and sets goals within the context of the corporate policy. Provides coaching, counseling and motivation to team members ensuring staff has the appropriate tools and support to be successful in their roles, while holding individuals accountable for individual and team goals.
• Creates a team oriented work climate that enables professional development and encourages creative solutions and strategies.
• Partners with Healthways and PCMH Leadership to ensure that best practices are in place.
• Helps to enhance and guide the evolution and success of PCMH Program through participation in multiple CareFirst initiatives, often providing strategic and tactical input.
• Actively supports PCMH workgroups and special projects including: User Acceptance Testing of IT systems, provider relations involvement, etc.
Required Knowledge and Experience:
• Master’s degree in a health care or business discipline, or equivalent work experience
• Minimum 7+ years of related experience working in Case Management, Home Health, or Disease Management or related clinical setting.
• Must have evidence of position(s) with increasingly progressive leadership responsibilities.
• A current DC, MD, or VA Registered Nurse License is required.
• Must possess extensive knowledge of managed care delivery guidelines and systems.
Required Skills and Abilities:
The following competencies are required to perform the aforementioned responsibilities successfully:
• Leadership/Coaching/Performance Management/Team Building
• Strategic and Analytical Thinking
• Staffing and Resource Planning
• Planning and Organizing
• Business Acumen
• Relationship Management
• Provider Education
• Clinical Quality and Process Improvement
• Influencing and Negotiating
• Oral Communication and Presentation Skills
• Project Management
• Advanced proficiency in Microsoft Office Suite
Must be able to effectively work in a fast paced environment with frequently changing priorities, deadlines, and workloads that can be variable for long periods of time. Must be able to meet established deadlines and handle multiple customer service demands from internal and external customers, within set expectations for service excellence. Must be able to effectively communicate and provide positive customer service to every internal and external customer, including customers who may be demanding or otherwise challenging.
• Sales or related experience in making calls to multiple “customers” is important.
• The physical demands described here are representative of those that must be met by the incumbent to perform the essential duties and responsibilities of the position successfully. Requirements may be modified to accommodate individuals with disabilities.
• Must be able to work in an office setting, primarily seated while performing duties for a minimum of 8 hours per work day.
• Must be able to provide own transportation to drive regularly to physician’s office and to satellite CareFirst Blue Cross Blue Shield offices.
• Walking and standing is required. Lift weight up to 25 pounds on occasion.
• Hands are regularly used to write, type, key and handle or feel small controls and objects. Must be able to type and to speak on the telephone simultaneously.
• Must have the ability to communicate verbally effectively. Auditory ability to actively listen.
Please apply before: July 19, 2016
Department: Regional Care Coordinator
CareFirst BlueCross BlueShield is an Equal Opportunity (EEO) employer. It is the policy of the Company to provide equal employment opportunities to all qualified applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, protected veteran or disabled status, or genetic information.
Must be eligible to work in the U.S. without Sponsorship
Actual salary will be based on relevant job experience and work history.
Where to apply: www.carefirst.com/careers