Exec Director Clinically Integrated Network

The Clinically Integrated Network (CIN) Chapter Director is responsible for MercyOne [Region]’s performance and transformation under value/risk-based care. The CIN Chapter Director is responsible for all aspects of Chapter Operations, including Care Management across the continuum and engagement of the Partnered Provider Network (PPN) to transform care. He/she will work collaboratively with the [Region] market and the MercyOne Population Health Services Organization (PHSO) on timely implementation of strategies/tactics as designed by the PHSO and the related governance structures.

MercyOne Western Iowa Clinically Integrated Network Chapter Executive Director

      

GENERAL SUMMARY:

The Clinically Integrated Network (CIN) Chapter Director is responsible for MercyOne [Region]’s performance and transformation under value/risk-based care. The CIN Chapter Director is responsible for all aspects of Chapter Operations, including Care Management across the continuum and engagement of the Partnered Provider Network (PPN) to transform care. He/she will work collaboratively with the [Region] market and the MercyOne Population Health Services Organization (PHSO) on timely implementation of strategies/tactics as designed by the PHSO and the related governance structures.

ESSENTIAL FUNCTIONS:

  • Participates as a member of MercyOne PHSO Administrative team and on PHSO governance structures as identified.
  • Ensures timely implementation of strategies/tactics as designed by the PHSO and PHSO related governance structures to effectively manage costs, utilization and, quality associated with value/risk-based contracts (e.g. MSSP, BPCI-A)
  • Ensures strategies/tactics are implemented and maintained. Including, but not limited to;
    • PHSO standard care management care models
    • PHSO standard care management staffing models
    • PHSO Practice Coach Program in support of Medical Groups
  • Including ICD-10 diagnosis coding initiatives (i.e. risk adjustment) and care gap closures (i.e. HEDIS performance improvement)
  • Provides oversight and leadership for Care Management across the continuum. Including, but not limited to;
    • Ambulatory: Health Coaches, Health Coach Assistants, Community Health Workers, Service Line Navigators, etc.
    • Post-Acute: Health Coaches, Coordinators, etc.
  • Maintains a strong working relationship with Acute Case Management, Utilization Management, Social Worker, etc.
  • Collaborates with Senior Leadership to align initiatives to PHSO directed strategies and direct clinical practices to improve efficiency, processes and outcomes.
  • Supports PHSO value-based priorities related to non-care management functions, including, but not limited to, increasing rates of Annual Wellness Visits and Advance Care Planning, and other opportunities as identified by PHSO Administrative team and PHSO governance structures.
  • Supports PHSO efforts related to NCQA Accreditation, including assisting with Survey preparation, and maintenance of related Accreditations and Certifications.
  • Supports PHSO shared data systems integration, enhancements, priorities, and development; and assists in Chapter level communications related to shared data systems.
  • Works with Senior Leadership to address discharge needs of inpatients and other inpatient issues as identified.  
  • Provides oversight of CIN compliance and works with PHSO Compliance staff to meet PHSO/CIN educational requirements, response to regulatory agencies, and co-facilitates corrective action plans as necessary. 
  • Has primary responsibility at the Chapter level for meeting PHSO performance goals.
  • Monitors CIN Department financial operations to ensure the organization utilizes its resources in a fiscally responsible manner.
  • Manages staff productivity to ensure the Chapter meets productivity standards and performance goals.
  • Coordinates with employed and independent Physician leadership to engage provider groups for success under value/risk-based programs, including patient-centered medical home recognition.   
  • As necessary, participates in the development of the clinically integrated network in a strategic manner, including assessments for network adequacy, access and efficiency/quality criteria, as well as identifying geographic expansion opportunities.
  • As necessary, engages local process improvement resources to develop, implement, and manage CIN focused improvement projects to succeed on value-based contracts and the implementation PHSO strategies.
  • Prepares business plans, proposals, special projects and presentations as requested.
  • Serves as the MercyOne [Region]’s subject matter expert on Chapter value-based contracts, including programmatic details, requirements, and performance to facilitate local education and enhance Chapter Staff knowledge.

MINIMUM KNOWLEDGE, SKILLS AND ABILITIES REQUIRED:

  • Bachelor’s degree in related field required. Master’s degree preferred.
  • A minimum of 5years experience as a leader in a multi-specialty physician group, integrated healthcare system, health plan, or PHSO is required.
  • Previous project management experience or process improvement background required.
  • Proficient in the use of databases and Microsoft Excel spreadsheet applications required.
  • Clinical background desirable.

EQUIPMENT/TOOLS:

  • Standardized office equipment found in assigned area.

REPORTING RELATIONSHIPS:

  • A2 Reporting Structure, reporting to the MercyOne PHSO President and MercyOne Region (Chapter) Appointed Senior Leader position (with required reporting to the Region President).

The above is intended to describe the general content of and requirements for this job. It is not intended to be a complete statement of duties, responsibilities or requirements.