Posted in Other 10 days ago.
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Type: Full Time
Location: Watertown, Massachusetts
We enjoy the important work we do every day on behalf of our members.
The Vice President, Population Health guides the strategic direction of Tufts Health Plan's population health and care management programs and provides vision and leadership in aligning multiple disciplines to deliver population appropriate interventions across all Tufts Health Plan product lines. The VP of Population Health is responsible for developing and implementing integrated models of care management programs and services that control medical costs, create clinical efficiencies, and improve member's health. In addition, the VP of Population Health applies their understanding of healthcare policy and financing, risk-based provider relationships, evolving reimbursement models and integration strategy in order to promote partnerships with providers, third-party specialized vendors, community organizations and advocacy groups. Strong leadership and team building skills are required. Leading this function for Tufts Health Plan will require change management skills as well as the ability to manage within complex organization structures. Prioritization and communication skills are critical to success, as managing the expectations of P&L leaders across the organization in support of their strategies is imperative. The VP of Population Health is directly accountable for achieving business results in areas of responsibility across the enterprise and in support of Tufts Health Plan's corporate strategic goals. Areas of functional responsibility include care management, care coordination, community outreach, disease management, clinical integration with ACO and other delegated provider arrangements, and prevention & wellness programs. Additionally, the implementation of automated workflow driven by targeted analysis of population health is required. Experience implementing advanced analytic workflow changes and innovative solutions will be preferred in this search.
KEY RESPONSIBILITIES/ESSENTIAL FUNCTIONS
- Works collaboratively with leaders across the enterprise at Tufts Health Plan to achieve strategic goals as related to the development and implementation of Population Health Management strategy and programs. Provides the organizational leadership with thought leadership and strategic subject matter expertise on matters related to Population Health Management.
- Leads the development of Tufts Health Plan's enterprise population health programs, standards, practices, programs, and initiatives, including oversight of vendors delegated for complex care management in our Dual's business and other government products.
- Works collaboratively with enterprise teams within the COOs area to develop consistent care management productivity and efficacy reporting and analytics to measure effectiveness of existing programs and development of potential new program interventions.
- Provides leadership to explore the adoption of a wider range of digital engagement tools which will allow Tufts Health Plan to increase engagement for members within high risk populations and allow for low cost alternatives to engaging with lower risk cohorts.
- Provides leadership and oversight to Enterprise team of clinical leaders and professionals, organizing and directing talent and resources to deliver results and achieve strategic goals while establishing/maintaining a collaborative and mission-driven team culture.
- Advise and inform Division Presidents and enterprise Clinical Leaders of business activities, performance, risks, opportunities, and recommended courses of action. Communicate with stakeholders such as brokers, large employer groups, contractors and regulators as required.
- Oversee integration of care management strategy and clinical operations with ACOs and other delegated provider organizations to meet long term goals of collaborative, value based reimbursement arrangements.
- Actively collaborates and partners with Medical Directors and the Office of the Chief Medical Officer to ensure physician involvement, as appropriate, in clinical initiatives.
- Works collaboratively with enterprise and division compliance leaders to maintain compliance with all applicable federal, state, and local legal and regulatory requirements. Directly accountable for ensuring areas of responsibility meet compliance requirements and standards.
- Oversees the establishment and delivery of initial and ongoing staff education programs. Actively promotes and supports professional advancement and career development among direct reports and other subordinates.
- Develops and implements care management policies and protocol, ensuring that care management staff is effectively managing cases according to the organization's high standards and all applicable state and federal legal and regulatory requirements.
- Develops and executes standards of care, documentation, consistency in decision-making application of regulatory guidelines, maintenance of member confidentiality, and coordination of services with other state contracted vendors.
- Maintains knowledge of industry trends by developing and maintaining relationships with industry and community groups. Represents Tufts Health Plan to external constituents.
- Undergraduate degree in a clinical discipline required, an advanced degree is highly preferred.
- A minimum of 10 years of related experience in progressive leadership roles in managed health care clinical programs, services, and administration. A minimum of 3 years successful performance in a clinical executive or general management role at the VP level or above.
- Experience working with provider entities and ACOs under value based arrangements and progressive payment models
- Experience with providing services under contract to state Medicaid agencies required and experience in either or both Medicare and/or programs for dually-eligible beneficiaries highly preferred.
- Knowledge of clinical management, project management, and process improvement and design required.
- Documented success in the proposing, bidding, and implementation of new state-sponsored business highly preferred.
- Detailed knowledge of the Massachusetts healthcare marketplace and working knowledge of prevailing national trends including the Affordable Care Act required.
- Documented success in establishing external relationships with community stakeholders highly preferred.
- Experience implementing advanced analytic workflow changes and innovative solutions highly preferred.
- Strong organizational skills
- Strong communication skills
- Ability to delegate to experienced directors
- Ability to manage up, down, and laterally very well
- Ability to manage large budget and large span of control (~500 FTEs and contractors)
CONFIDENTIAL DATA: All information (written, verbal, electronic, etc.) that an employee encounters while working at Tufts Health Plan is considered confidential. Exposed to and required to deal with highly confidential and sensitive material and must adhere to corporate compliance policy, department guidelines/policies and all applicable laws and regulations at all times. #LI-DD1
What we build together changes our customer's health for the better. We are looking for talented and innovative people to join our team. Come join us!.
Tufts Health Plan is an equal opportunity employer. Qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability or protected veteran status. For our EEO Policy Statement, please click here. If you d like more information on your EEO rights under the law, please click here.