Leads the implementation of Health Services clinical operations for products offered through the VNSNY Management Services Organization (MSO). Collaborates with leadership across the Enterprise to create and implement efficient clinical processes, ensure appropriate utilization and develop evidence-based care management policies and procedures to support new MSO products and meet regulatory standards. Collaborates with other disciplines to ensure workflows are comprehensive for clinical handoff to provider, claims and enrollment. Works under limited direction.
Develops thorough understanding of Management Services Organization (MSO) customer clinical service needs; leads the design of clinical and operational model of MSO products to meet these needs.
Defines core clinical processes required for successful implementation of new MSO products.
Collaborates with IT, BIA, and other support areas to ensure the appropriate infrastructure is in place for the MSO to effectively deliver operationally excellent MSO services.
Collaborates with Quality, Education, and Compliance to ensure MSO clinical services are high-quality, consistent with best practices, and compliant with regulatory requirements.
Develops implementation plans and roadmaps for MSO clinical service roll-out.
Identifies staffing needs for MSO clinical programs and collaborates with HR to spearhead the recruitment and onboarding of staff.
Develops and revises workflows, with emphasis on cost improvement, timeliness and automation.
Leverages existing or defines new monitoring tools; works with business staff develop and implement.
Monitors performance and productivity of the team and individual members; leads appropriate operational changes and takes action to ensure guidelines and goals of the customer agreement is met.
Ensures issues and deficiencies identified during internal or external audits are addressed and corrected.
Partners with internal and customer implementation delivery teams and plays advisory role related to partner implementation, delivery and optimization.
Participates in special projects and performs other related duties as requested.
Education: Master's degree in business, healthcare or related field or equivalent work experience required.
Experience: Minimum of eight years of progressive health care operations management experience required. Strong knowledge of health care delivery systems, medical management IT platforms, managed care, and patient care required. Strong knowledge of federal and state health care regulations related to Medicare, Medicaid, managed care, and long-term care required. Strong knowledge of geriatrics, community-based care, and long-term care required. Demonstrated ability to collaborate and interact cooperatively with all levels of management and their staffs required. Strong systems thinking and process improvement success skills required. Strong analytical skills and excellent oral, written and interpersonal communication skills required. Proficient PC skills, including MS Excel and Word required.