Division Director of Care Coordination RN
HCA Healthcare, Charleston, South Carolina, United States, 29408
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 Director will lead the clinical implementation efforts for all VBC programs in assigned division(s) including 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.
Duties and Responsibilities
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, including RN Care Managers, LCSW Care Managers, and Care Coordinators.
Provides division-level leadership in development, direction, execution, and evaluation of an effective VBC and care coordination program that supports quality healthcare delivery.
Participates in development of VBC program and care coordination goals and objectives, establishes and implements workflows, policies and procedures in alignment with enterprise standards.
Responsible for planning, priority setting, coordination, implementation, evaluation and reporting of programs related to VBC and care coordination in assigned division(s).
Manages benchmarks to evaluate care coordination program effectiveness and efficiency.
Develops division-level systems to ensure effective communication and coordination between care coordination teams and PSG Corporate leadership, Group leadership, Division leadership, PSG operations, Payor Contracting & Alignment, and other business partners.
Collaborates with interdisciplinary teams to achieve coordination of care goals, VBC performance goals, quality goals, and financial performance goals.
Creates and manages structure and systems that efficiently identify number of care coordinators and care managers required based on number of beneficiaries and program complexity.
Supports preparation and maintenance of VBC program and care coordination reports; prepares periodic reports for PSG division leaders.
Serves as division Government Programs Coordinator ensuring all division PSG-managed providers across 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 effective estimation of 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 essential; able to interact and establish immediate credibility with all levels of 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.
Benefits and Company Overview HCA Healthcare is one of the world's most ethical companies® recognized by the Ethisphere Institute more than ten times. We support HCA's commitment to the care and improvement of human life. We provide direction for over 260 exceptional resident and fellowship programs and lead more than 1,300 physician practices and 170+ urgent care centers.
Equal Opportunity Employer 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.
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Duties and Responsibilities
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, including RN Care Managers, LCSW Care Managers, and Care Coordinators.
Provides division-level leadership in development, direction, execution, and evaluation of an effective VBC and care coordination program that supports quality healthcare delivery.
Participates in development of VBC program and care coordination goals and objectives, establishes and implements workflows, policies and procedures in alignment with enterprise standards.
Responsible for planning, priority setting, coordination, implementation, evaluation and reporting of programs related to VBC and care coordination in assigned division(s).
Manages benchmarks to evaluate care coordination program effectiveness and efficiency.
Develops division-level systems to ensure effective communication and coordination between care coordination teams and PSG Corporate leadership, Group leadership, Division leadership, PSG operations, Payor Contracting & Alignment, and other business partners.
Collaborates with interdisciplinary teams to achieve coordination of care goals, VBC performance goals, quality goals, and financial performance goals.
Creates and manages structure and systems that efficiently identify number of care coordinators and care managers required based on number of beneficiaries and program complexity.
Supports preparation and maintenance of VBC program and care coordination reports; prepares periodic reports for PSG division leaders.
Serves as division Government Programs Coordinator ensuring all division PSG-managed providers across 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 effective estimation of 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 essential; able to interact and establish immediate credibility with all levels of 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.
Benefits and Company Overview HCA Healthcare is one of the world's most ethical companies® recognized by the Ethisphere Institute more than ten times. We support HCA's commitment to the care and improvement of human life. We provide direction for over 260 exceptional resident and fellowship programs and lead more than 1,300 physician practices and 170+ urgent care centers.
Equal Opportunity Employer 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.
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