Job Information
Martin's Point Health Care Senior Director Clinical Programs - Remote in Portland, Maine
Join Martin's Point Health Care - an innovative, not-for-profit health care organization offering care and coverage to the people of Maine and beyond. As a joined force of "people caring for people," Martin's Point employees are on a mission to transform our health care system while creating a healthier community. Martin's Point employees enjoy an organizational culture of trust and respect, where our values - taking care of ourselves and others, continuous learning, helping each other, and having fun - are brought to life every day. Join us and find out for yourself why Martin's Point has been certified as a "Great Place to Work" since 2015.
Position Summary
The Senior Director Clinical Programs provides oversight and coordination of care management and disease management related activities, objectives, and analysis for the Martin’s Point Health Plan. The Senior Director is responsible for Care Management design, implementation and operations and will work closely with VP of Health Plan Clinical Program and Director of Health Management to ensure the clinical departments can support enterprise-level growth, clinical outcomes, and medical trend targets. This includes creating new or redesigning existing product programs to achieve the triple aim.
The Senior Director Care Management leads a team to execute on program strategy, design and implementation through project management, and the ability to foster support for program enhancements across all levels of the organization. Partnering with all Health Plan and shared service departments, the Senior Director Care Management will support the above through coordination of government and regulatory affairs, industry best practices and innovation, population health strategies and clinical integration.
Job Description
Key Outcomes:
Proposes and plans new programs and services to meet population health needs, customer expectations, and activities to manage medical costs and focus on health outcomes.
Develops objectives across the department to ensure compliance with professional and regulatory standards, federal contracts, and accreditation standards.
Develops and leads high performing care management coordination activities to reduce cost per capita for all member populations while ensuring members receive appropriate and needed services.
Leads care management and disease management activities for Martin’s Point to improve clinical and medical trend outcomes.
Oversees all reporting to monitor the progress and outcomes of all care management and disease management activities carried out by the department including reporting to regulatory and accrediting agencies.
Manages relationships and coordination with external vendors and delegated entities. Responsible for Delegation Oversight of Clinical vendors
Develops and manages Key Performance Indicators (KPIs) for care management and disease management.
Partners with cross functional teams to successfully enhance existing clinical program’s structure to address the needs of members, support the work of care teams, and align with our company objectives.
Proposes, designs, and oversees implementation of care management redesign and new products and services to meet population health needs, customer expectations, and activities to manage medical costs and focus on health outcomes.
Ensures all program design and redesigns are in compliance with professional and regulatory standards, federal contracts, and accreditation standards.
Collaborates across health plan clinical programs as well as other key health plan departments and the delivery system to ensure alignment of clinical and operational initiatives and activities.
Collaborates with the Director Health Plan Quality to support initiatives such as HEDIS, Member Safety, QIPs, QII’s, CMS Stars and accreditation.
Collaborates with clinical teams across Health Management synthesizing clinical outcome drivers and quality/operational requirements into an aligned program, strategy to deliver high-impact clinical outcomes, client value and business results.
Education/Experience
Bachelor’s degree in a clinical field of study (RN, Pharmacy, etc.); Master’s degree in nursing or related field preferred
10 years of experience in health care including experience in care management/ disease management, utilization management and prior authorization.
Experience developing and managing health plan program strategy, design, redesign, clinical platform conversions, implementation, and evaluation.
Experience using data and data analysis to design programs, manage care coordination services, and manage success of programs.
Strong project management experience required.
Experience in Medicare Advantage and TRICARE preferred.
Required License(s) and/or Certification(s):
- RN, NP, PA, PharmD or similar level of clinical licensure
Skills/Knowledge/Competencies (Behaviors):
Broad knowledge of managed care and health plan functions; Medicare Advantage required; USFHP and/or TRICARE knowledge is a plus
Demonstrated project management skills overseeing complex projects in matrix environment.
Strong attention to detail and the ability to multitask.
Excellent communication and presentation skills, oral and written.
Demonstrates an understanding and alignment with Martin’s Point Values
Knowledge of NCQA/URAC accreditation as well as CMS requirements, and State and Federal regulations
Knowledge of Medicare Advantage regulations, CMS Stars, and HEDIS.
Knowledge of reimbursement models, utilization patterns, and quality improvement opportunities
Strategic ability to see the big picture and lead a team through change
Ability to operationalize a concept
Strong organizational skills including the ability to work independently and prioritize work.
Ability to review, interpret and present information to Health Plan Leadership and external partners.
Ability to lead change and assist in the development of change strategies in support of Health Plan and Organizational goals and objectives.
Competence with computers and business applications; Microsoft Excel, Word, PowerPoint, Outlook, Access.
Excellent written and verbal communication skills with the ability to write executive reports and power point presentations as well as the ability to present findings in internal and external settings.
This is a remote position with occasional travel to Portland, Maine.
We are an equal opportunity/affirmative action employer.
Do you have a question about careers at Martin’s Point Health Care? Contact us at: jobinquiries@martinspoint.org
Martin’s Point Health Care is a progressive, not-for-profit organization providing care and coverage to the people of Maine and beyond. The organization operates six primary care health care centers in Maine and New Hampshire, accepting most major insurance plans. Martin’s Point also administers two health plans: Generations Advantage (Medicare Advantage plans available throughout Maine and New Hampshire), and the US Family Health Plan (TRICARE Prime® plan for active-duty and retired military families in northern New England, upstate New York, and western Pennsylvania). For more information, visit https://careers.martinspoint.org .
