"Alerted.org

Description

This position is incentive eligible.

Job Summary and Qualifications

The Division Director of Care Coordination is based in Charleston, SC and leads the implementation and management of a standardized care coordination model across the division with Physician Services. Travel across the division is required and to corporate headquarters in Nashville, TN. The Division Director will lead the clinical implementation efforts for all VBC programs in assigned division(s) including but not limited to: Centers for Medicare and Medicaid Innovation (CMMI) projects; Accountable Care Organizations; Advanced Alternative Payment Models; Medicare Advantage including HEDIS performance; and commercial payer value programs.

The Division Director is responsible for developing and implementing clinical and care coordination processes that support the exceptional performance of Physician Services providers participating in HCA Value Based Entities (VBE) within their division(s) and functions as the primary clinical partner for the VBE.

The Division Director leads a team of RN care managers, LCSW care managers, and unlicensed care coordinators located in assigned divisions; facilitates excellent working relationships with multiple internal business partners; and develops and maintains strong partnerships with group and division operations and clinical leaders. Additionally, the Director establishes effective relationships and partnerships with external business partners such as CMS, national payer teams, and local payer representatives.

In collaboration with division controllers and Payer Contracting & Alignment teams, develops and maintains payer-specific financial reports to determine program revenue potential and received program payments. The Director will also serve as their assigned division(s)’ Government Programs Coordinator and ensures all division Physician Services-managed providers across all specialties and service lines are compliant with MIPS/MACRA.

This position requires excellent communication skills, an adaptive leadership style, a focus on execution, and the ability to work effectively in the rapidly changing payer reimbursement space.

DUTIES INCLUDE BUT NOT LIMITED TO:

+ Scope of role encompasses managing 100K-250K value-based care lives across multiple payer agreements with at least $1M in potential upside and/or downside risk

+ Supervises and provides leadership, guidance and structure to remote and on-site care coordination positions, which include RN Care Managers, LCSW Care Managers, and Care Coordinators

+ Provides division-level leadership in the development, direction, execution, and evaluation of an effective VBC and care coordination program that supports the delivery of quality healthcare in the most appropriate and effective manner. Program must meet the obligations of contractual and regulatory requirements and the short-term and long-term goals of PSG.

+ Participates in the development of VBC program and care coordination goals and objectives, and establishes and implements workflows, policies and procedures in alignment with enterprise standards

+ Responsible for the planning, priority setting, coordination, implementation, evaluation and reporting of programs related to VBC programs and care coordination in assigned division(s)

+ Manages to a set of benchmarks to evaluate the care coordination program’s effectiveness and efficiency

+ Develops division-level systems to ensure effective communication and coordination between the care coordination teams and PSG Corporate leadership, Group leadership, Division leadership, PSG operations, Payor Contracting & Alignment, and other business partners

+ Collaborates with interdisciplinary teams and leaders to achieve the organization’s coordination of care goals, VBC performance goals, quality goals, and financial performance goals

+ Creates and manages to a structure and system that efficiently identifies the number of care coordinators and care managers required based on the number of beneficiaries and program complexity

+ Supports the preparation and maintenance of VBC program and care coordination reports and prepares periodic reports for PSG division leaders

+ Serves as division Government Programs Coordinator and ensures all division PSG-managed providers across all specialties and service lines are compliant with MIPS/MACRA

+ Participates in cross-functional contract reviews and constructs recommendations for participation, staffing needs, and methods for execution

+ Establishes and maintains an effective way to estimate value based care contracted lives for assigned divisions

+ Works with Finance, Payer Contracting & Alignment, and division controllers to monitor value based care revenues and revenue opportunities from value based care agreements

+ Maintains comprehensive knowledge of payer and regulatory requirements with ability to work effectively under pressure and adapt to changing priorities.

+ Keeps abreast of industry trends and guides teams to adapt to meet evolving needs of payers, government programs and the healthcare industry.

+ Excellent influencing, negotiation, relationship-building and communication skills are essential with the ability to effectively interact and establish immediate credibility with all levels of the HCA Physician Services Group Division executive and operations teams, physicians, staff and payer representatives

+ Strong ability to think strategically and anticipate future changes with a performance excellence, outcomes-focused mindset

+ Performs related work and additional duties as requested

+ Able to mentor, influence, and manage through highly matrixed reporting relationships

+ Maintains the strictest confidentiality in the areas of patient, employee and physician relations

+ Practices and adheres to the “Code of Conduct” philosophy and “Mission and Value Statement”

Qualifications:

+ Current licensure as a Registered Nurse in state of residence

+ Bachelor’s degree in nursing, business, or other healthcare-related field required;

+ Minimum 5 years of related clinical and management experience involving care coordination, ambulatory care, quality improvement, leadership, and/or healthcare quality, as well as associated regulatory rules and laws. At least 3 years must have been in capacity as direct supervisor of other professional level and clinical employees.

Physician Services Group (https://careers.hcahealthcare.com/pages/physician-services) is skilled in physician employment, practice and urgent care operations. We are experts in hospitalist integration, and graduate medical education. We lead more than 1,300 physician practices and 170+ urgent care centers. We are HCA Healthcare's graduate medical education leader. We provide direction for over 260 exceptional resident and fellowship programs. We focus on carrying out value-added solutions. These solutions help physicians deliver patient-centered healthcare. We support HCA Healthcare's commitment to the care and improvement of human life.

HCA Healthcare has been recognized as one of the World's Most Ethical Companies® by the Ethisphere Institute more than ten times. In recent years, HCA Healthcare spent an estimated $3.7 billion in cost for the delivery of charitable care, uninsured discounts, and other uncompensated expenses.

"Bricks and mortar do not make a hospital. People do."- Dr. Thomas Frist, Sr.

HCA Healthcare Co-Founder

If you are looking for an opportunity that provides satisfaction and personal growth, we encourage you to apply for our Division Director of Care Coordination opening. We promptly review all applications. Highly qualified candidates will be contacted for interviews. **Unlock the possibilities and apply today!**

We are an equal opportunity employer. We do not discriminate on the basis of race, religion, color, national origin, gender, sexual orientation, age, marital status, veteran status, or disability status.