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Director, MassHealth ACO Clinical Services - Great Role in Growing Product Line!

Company: Fallon Community Health Plan
Location: Worcester
Posted on: November 20, 2020

Job Description:

Job Description Director, MassHealth ACO Clinical Services - Great Role in Growing Product Line! US-MA-Worcester Job ID: 6027 Type: Full Time # of Openings: 1 Category: Medical Management Fallon Health - Corp HQ Overview About Fallon Health Founded in 1977, Fallon Health is a leading health care services organization that supports the diverse and changing needs of those we serve. In addition to offering innovative health insurance solutions and a variety of Medicaid and Medicare products, we excel in creating unique health care programs and services that provide coordinated, integrated care for seniors and individuals with complex health needs. Fallon has consistently ranked among the nation's top health plans, and is accredited by the National Committee for Quality Assurance for its HMO, Medicare Advantage and Medicaid products. For more information, visit fallonhealth.org OPPORTUNITY OVERVIEW A couple of years ago the Baker-Polito administration set out on a new and innovative initiative deemed MassHealth's Accountable Care Organization (ACO) program with 18 health care organizations participating as partners across the state of Massachusetts. These organizations are working together to provide better integrated health care for their patients with the goals of improving their health and containing costs. These ACOs are expected to cover over 900,000 MassHealth members and include approximately 4,500 primary care providers. Fallon Health is an integral part of this this exciting initiative with three key ACO provider partnerships in place and we have a fantastic new opportunity for a Director level leader to join us and oversee the Clinical team . This is a wonderful position for the right leader in this field to come in and make their mark and leverage creativity, collaboration, innovation and strong leadership in taking this program to the next level and helping set a vision and strategy for its current and future success. Summary: * Is accountable for the direction and management of the MassHealth ACO clinical services area, including the development, implementation, maintenance, and monitoring of all clinical programs required in the Mass Health contract. * Collaboratively works with Fallon Health Medical Director for ACOs, Fallon Health ACO Operations Team, ACO Partner Leaders, Community Partners, ACO Leaders, and Clinical Integration Leaders to implement the ACO Model of Care as outlined in the State Contract * Develops effective and productive working relationships with ACO partners, representing Fallon Health's needs and the ACO partner needs * Analyzes and strategically leads workflows and process development to demonstrate and implement actions required for ACO Contract compliance * Establishes positive and proactive working relationships with the ACO partners for 'all things' associated with care management and works with Manager, ACO Operations to ensure TruCare and documentation needs and system reporting works collaboratively between Fallon Health and the ACO Partners * Participates, in collaboration with the FH Medical Director for ACOs, in model of care strategy development and ongoing planning and analysis * Collaborates with Fallon Health Medical Director to develop, refine, and monitor ACO program metrics * Works cross functionally and coordinates the involvement of key FH employees within IT, regulatory, UM, Care Services, NDM, and medical economics to ensure client needs are well integrated with the rest of FH business * Maximizes the efficiency of the documentation system to ensure effective reporting of team and partner care management actions collaborating with Clinical Integration Leaders when appropriate * Ensures effective, collaborative use of the TruCare system between multiple ACO partners and Fallon Health being firm to ensure clear and effective reporting from the system * Develops and oversees the implementation of an effective onboarding process for new ACO members in partnership with Fallon Health Customer Service Staff and Unit staff * Manages a multi-location clinical team to ensure timely coordination of quality healthcare and care coordination services for Fallon Health members with varying levels of conditions * Provides leadership, supervision, and support for Unit staff fostering integration within ACO Partner care teams * Ensures documentation of all workflows and processes conducted by staff working on the ACO product line are complete and updated according to Corporate requirements and/or process changes * Ensures team functions are audited according to Corporate, Program, and Department Policies/Processes and works with Leaders to implement corrective actions as warranted * Ensures Manager, ACO Operations develops a TruCare User Manual specific for the ACO Partners and trains new partner staff on the System * Oversees processes to manage and controls access for ACO Partners to the TruCare system working in conjunction with I.T. to ensure proper documentation is in place for th

Keywords: Fallon Community Health Plan, Worcester , Director, MassHealth ACO Clinical Services - Great Role in Growing Product Line!, Other , Worcester, Massachusetts

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