Description

Director of Case Management 

• Partner with clinical leadership to develop case management strategy, including the ideal team structure, training, workflow, productivity, engagement, analytics and outcome measurement.
• Develop roadmap that defines the path to operationalize specific actions which are repeatable, measurable, and cost-effective.
• Implement and monitor best practices and workflows
• Build and strengthen relationships with partner providers and nursing facilities/ ALFs and Board and Care facilities.
• Manage, support, and develop team members for continuous improvement; create and implement performance improvement plans when needed
• Ensure care coordination and other support staff are properly trained, integrated within their teams, and productive in their outcomes and quality of work.
• Ensure all staff have adequate training and skills to engage patients, facilities and providers.
• Support and collaborate with data management and IT/IS teams to ensure effective and efficient processes to collect and measure program performance metrics.
• Report program activity and progress regularly to Senior Management
• Develop a process to review program policies and procedures and modify periodically as necessary, as well as quality assurance practices.
• Responsible for the supervision of the daily operations of case management functions.  Ensures that patients are care managed according to CareConnectMD mission, vision and values. 
• Works with staff in the assessment of current patient needs (post-acute settings, transitions of care, home care) and providing additional resources and referrals. Seeks consultation with others when needed, such as social services, behavioral health, and durable power of attorney.
• Supports a culture of learning and excellence
• This position may require travel and on call

Education and Experience

• Licensed RN or BSN
• At least 3 years of experience in case management for value-based care (health plan, delegated provider group, ACO, etc.)
• Certification in case management a plus
• Experience in managing patients in post-acute settings
• Experience in working with frail, medically complex patients 

Essential Skills and Abilities

• Able to effectively fulfill managerial responsibilities in accordance with the organization’s policies and applicable laws to front line staff in a fair and consistent manner.
• Ability to solve practical problems and deal with a variety of concrete variables in situations where only limited standardization exists. Ability to interpret a variety of instructions furnished in written, oral, diagram or schedule form.
• Proficiency with MS Office
• Thrives in an unstructured, start-up environment.
• Self-starter that can work independently and collaboratively, prioritize tasks and has initiative and excitement to take on unfamiliar tasks.
• Effectively communicate with all levels of management, patients, and family members.
• Creative, flexible, well organized, resourceful, and detail-oriented
• Excellent judgment in handling confidential and sensitive information
• Excellent at establishing and maintaining cooperative working relationships with colleagues and clinicians
• Ability to work across locations and time zones

License/Certification

• Licensed Nurse (RN, BSN)
• Current/Valid state driver’s license and insurance  

Core Competencies

• Instills trust
• Customer focus
• Manages ambiguity
• Collaborates
• Drives results

The anticipated base pay range for this position is $125,000 - $150.00 Individual pay is determined by job-related skills, experience, and relevant education or training.

Please send resumes to [email protected]

Provider Relations Specialist

Key Duties and Responsibilities

• Regularly engage with partners providers to participate in JOC meetings, support coordinate visits, and educate providers to utilize our 24/7 service for ER diversion.
• Tailor engagement and best practices shared with each partner provider to enhance day to day operations to impact key metrics.
• Provide providers and facilities the actionable metrics and tools to drive improvement and connect providers to appropriate departments when needed.
• Provide access to CareConnectMD resources like education by certified coders, and office staff training.
• Support and leverage CCMD’s offered services e.g., case management resources, business development, and clinical services to reach our desired outcomes.
• Function as point-of-contact for all partner providers and facilities.
• Communicate effectively with providers to confirm existing patient experience initiatives and areas of needed improvement.
• Interact with providers, office managers, staff in a positive, collaborative, and professional manner.
• Work effectively with operational/clinical/BD team to issues that may be impacting performance.
• Adhere to productivity set by the department leadership.
• Continually search for opportunities to streamline and improve workflows and operations so we can more effectively ensure the quality of our provider and facility experience.
• Other duties as assigned.

Education and Experience

• Bachelor's Degree and 3+ years of experience working in health care provider services required.
• Strong presentation, relationship building, problem-solving, critical thinking, and decision-making skills required.
• Strong oral and written communication skills required.
• Demonstrate ability to manage multiple projects and meet deadlines.
• Ability to work independently with minimal supervision required.
•  Excellent organizational and time management skills required.
•  Proficiency in MS Word, Excel, PowerPoint, and Outlook required.
• Travel will be needed, must have valid CA driver's license, car insurance, and reliable vehicle.

Essential Skills and Abilities

• Thrives in an unstructured, start-up environment.
• Self-starter that can work independently and collaboratively, prioritize tasks and has initiative and excitement to take on unfamiliar tasks.
• Advanced knowledge of word processing, graphic presentation and computer software related to specific tasks
• Demonstrated excellent computer and word processing skills with special emphasis on calendaring, presentation, and spreadsheet capabilities
• Working knowledge of company policies, procedures, and operations
• Excellent composition, grammar, and business language skills
• Excellent communication and interpersonal skills with the ability to effectively communicate with all levels of management, patients, and family members.
• Creative, flexible, well organized, resourceful, and detail-oriented
• Excellent judgment in handling confidential and sensitive information
• Ability to work independently, set priorities and handle multiple tasks with a high level of efficiency
• Establishing and maintaining cooperative working relationships with others
• Ability to work across locations and time zones

Core Competencies

• Instills trust
• Customer focus
• Manages ambiguity
• Collaborates
• Drives results

This is a hybrid role working 2-3 days in the Costa Mesa office and the other days remotely. 

The anticipated base pay range for this position is $25.00 - $28.00 per Hour. Individual pay is determined by job-related skills, experience, and relevant education or training.

Please send resumes to [email protected]

Case Manager

CareConnectMD DCE is a specialized High Needs Direct Contracting Entity (DCE) geared towards medically complex Medicare beneficiaries who reside in nursing homes, assisted living facilities, board and care facilities and at home. The comprehensive program provides a care model that is designed to meet the unique health care needs of medically complex Medicare beneficiaries. Under this value-based care model, CareConnectMD DCE will deliver care coordination services in close collaboration with primary care physicians, specialists, and advanced practice professionals in California, Georgia, Ohio, Indiana, Texas, as well as other expansion locations.

Learn more at www.careconnectmd.com

Key Duties and Responsibilities

• Ensures that patients are care managed according to CareConnectMD mission, vision and values. 
• This position is responsible for the assessment, care planning and coordination of care and evaluation of services for Medicare Beneficiaries aligned with the High Needs ACO with CareConnectMD. 
• Patient’s wishes are aligned and known to team. Participate in goals of care discussion.
• Maintains and follows a panel of patients, ensuring patients’ needs are addressed in collaboration with the primary care clinician team. This includes patients residing long term in skilled nursing facilities, board and care, assisted living facilities as well as home.
• Monitor patients when they are transferred to an acute setting (ED, hospital, LTAC), obtaining updates on patients for Clinical Team, facilitating transition of care and continuing to follow patient in the post-acute setting.
• Serves as the primary point of contact for care coordination throughout the treatment episode at all levels of care.
• Coordinates and communicates with the interdisciplinary team to effectively manage care plans and transition of care settings. Communicates regularly with patient’s primary care provider and other clinicians.
• Collaborates and communicates with family members to optimize outcomes.
• Participates in multidisciplinary meetings, respecting and promoting patient choice and documents informed decision making.
• Maintains timely, complete, and accurate documentation in compliance with regulatory policies and procedures.
• Collaborates with nursing facility staff to ensure that patient is receiving care that is appropriate and consistent with medical necessity.
• Reviews and monitor patients’ utilization of skilled Part A and Part B services in nursing facility to include documentation of medical necessity and continued stay review.
• Acts as an effective liaison to facilities (hospital, skilled nursing, assisted living, memory care, and mental health) to ensure continuity and congruity of services in accordance with the patient’s Plan of Care.
• When on-site meets with patient and family to address needs.

Education and Experience

• At least 2 years of experience in case management
• Experience in working in a long-term care setting preferred
• Experience in working with frail, medically complex patients
• Experience with Microsoft 365 (Microsoft word, excel, power point, Teams meetings, calendaring)
• Experience working with electronic medical records

Essential Skills and Abilities

• Ability to solve practical problems and deal with a variety of concrete variables in situations.
• Works independently, set priorities and handle multiple tasks with a high level of efficiency.
• Creative, flexible, well organized, resourceful, and detail-oriented
• Ability to handle confidential and sensitive information
• Excellent communication and interpersonal skills with the ability to effectively communicate with all levels of management, patients, and family members, various healthcare settings including clinic, hospitals, skilled nursing facilities for example
• Establishing and maintaining cooperative working relationships with others
• Excellent composition, grammar, and business language skills
• Work across different locations and time zones

License/Certification

• Licensed Nurse (LVN or RN)
• Current/Valid state driver’s license and insurance
• Must be a licensed driver with an automobile that is insured in accordance with state or organization requirements and is in good working order.

Core Competencies

• Instills trust
• Customer focus
• Manages ambiguity
• Collaborates
• Drives results

Please send resumes to [email protected]

Are you passionate about revolutionizing healthcare for the elderly and medically complex population? If you are, CareConnectMD would like to meet you!

Since 1996, CareConnectMD (formerly Gerinet Medical Associates) has been providing personalized and compassionate medical care for our frail and medically complex patients in skilled nursing and long-term care facilities. Our 22 years of managing care for high-risk populations has helped us design an integrated care model that effectively coordinates care as our patients transition from inpatient to post-acute settings, including going home. Our unique value-based care model improves clinical outcomes and patient/family satisfaction, while reducing overall system costs. We are experts in symptom management, supportive care, advanced care planning, telemedicine, medical crisis prevention, and patient-family communication.

Our Culture:

Many employers say they offer work-life balance, but few are able to deliver on that promise. CareConnectMD providers do not practice on a shift-basis, so they have more flexible schedules that work around raising their families and other important priorities. With us, there are no surprise 12-hour work shifts or increasing unpaid time for after-hour clinic work duties. Retention is important to us, so we want to make sure our providers enjoy great qualities of life. CareConnectMD provides after-hours call coverage support, so you can enjoy your time away from work without being interrupted by calls. 

AOC Reach Nurse Practitioner will conduct annual wellness visits and create or update a personalized prevention plan to prevent illness based on current health and risk factors and optimize the management of the patient’s current medical conditions. This will include performing various tests, screenings, providing general and preventative care, collecting family history information and meticulous charting.  Accurate and timely documentation is essential in providing quality care.

The ideal candidate is passionate about providing high-quality care and constantly striving for excellence.

Key Duties and Responsibilities

• Conduct comprehensive annual wellness evaluations for traditional Medicare beneficiaries enrolled in the ACO REACH program, focusing on elderly and vulnerable individuals residing in disadvantaged areas.
• Collaborate with a multidisciplinary team to develop individualized care plans based on assessment findings, patient goals, and medical history.
• Perform thorough physical assessments, including reviewing medical histories, conducting physical examinations, and assessing mental health status.
• Administer and interpret diagnostic tests, screenings, and laboratory results to identify potential health issues or risks.
• Educate patients and their families about preventive care strategies, disease management, medication adherence, and lifestyle modifications to promote overall wellness.
• Address patients' concerns, answer questions, and provide guidance on healthcare decisions, ensuring patients are well-informed and empowered to actively participate in their care plans.
• Utilize the ACO REACH program's tools and resources to enhance care quality, coordination, and accessibility, while maintaining the integrity of traditional Medicare features and flexibilities.
• Collaborate with primary care physicians, specialists, social workers, and other healthcare professionals to ensure seamless communication and coordination of care for each patient.
• Document evaluations, assessments, interventions, and care plans accurately and comprehensively in the electronic health record system.
• Continuously stay informed about geriatric best practices, evidence-based guidelines, and relevant healthcare policies to provide the highest standard of care.
• Participate in regular team meetings, quality improvement initiatives, and ongoing education to optimize care delivery within the ACO REACH program.

Education and Experience

• Master's degree with a minimum of one (1) year Nurse Practitioner experience (required) experience with performing Annual Wellness Exams, and a minimum of one (1) year hospice or palliative care experience (preferred).
• Must be Board Certified and holds DEA license.
• State certification as Family/ Adult/Geriatric nurse practitioner
• Current CPR certification
• Experience in geriatrics and skilled nursing facilities preferred.
• Certification in a specialist area preferred; (e.g. Hospice and Palliative Nursing (CHPN), or Geriatrics)
• Excellent observation, verbal and written communication skills, problem solving skills, mathematical skills; nursing skills per competency checklist.
• Prolonged or considerable walking or standing. Able to lift, position and/or transfer patients. Able to lift supplies and equipment. Considerable reaching, stooping, bending, kneeling and/or crouching. Visual acuity and hearing to perform required nursing skills.

Essential Skills and Abilities

• Thrives in an unstructured, start-up environment.
• Self-starter that can work independently and collaboratively, prioritize tasks and has initiative and excitement to take on unfamiliar tasks.
• Advanced knowledge of word processing, graphic presentation and computer software related to specific tasks.
• Demonstrated excellent computer and word processing skills with special emphasis on calendaring, presentation, and spreadsheet capabilities.
• Working knowledge of company policies, procedures, and operations
• Excellent composition, grammar, and business language skills
• Excellent communication and interpersonal skills with the ability to effectively communicate with all levels of management, patients, and family members.
• Creative, flexible, well organized, resourceful, and detail-oriented
• Excellent judgment in handling confidential and sensitive information
• Ability to work independently, set priorities and handle multiple tasks with a high level of efficiency.
• Establishing and maintaining cooperative working relationships with others
• Ability to work across locations and time zones.

Licenses/Certifications

• Must be Board certified and have a DEA License
• State certification as adult/geriatric nurse practitioner
• Current CPR certification

Core Competencies

• Instills trust
• Customer focus
• Manages ambiguity
• Collaborates
• Drives results

Please send resumes to [email protected]

CareConnectMD DCE is a specialized High Needs Direct Contracting Entity (DCE) geared towards medically complex Medicare beneficiaries who reside in nursing homes, assisted living facilities, board and care facilities and at home. The comprehensive program provides a care model that is designed to meet the unique health care needs of medically complex Medicare beneficiaries. Under this value-based care model, CareConnectMD DCE will deliver care coordination services in close collaboration with primary care physicians, specialists, and advanced practice professionals in California, Georgia, Ohio, Indiana, Texas, as well as other expansion locations. Learn more at www.careconnectmd.com

Summary

A team coordinator is a professional who provides administrative roles that help to facilitate the daily functions and operations of an organization. Team coordinators must work closely with the team leader to keep the team running smoothly.

• Schedule meetings, prepare agendas for meetings, and prepare meeting minutes.  
• Tracking task and project progress 
• Prepare operational reports e.g., productivity, and CCE visits.  
• Respond to operational team requests. 
• Organize ShareFile, update and maintain share file folders for each partner provider,  
• Prepare PowerPoint presentations for meetings as needed. 
• Support patient, provider, and facility outreach initiatives to coordinate service delivery. 
• Maintains active and accurate ACO REACH patient census, by region, sites, location, and providers.  
• Maintains updated information in Electronic Medical Record (EMR) 
• Runs standard reports including metrics, census, hospitalization, emergency visits, etc. 
• Demonstrates proficiency in computer navigation and medical/financial databases communications.  
• Typing up copy for presentations 
• To assist on occasions in preparing presentations using Power Point (essential)  
• Prepare JOC decks and maintain JOC calendar. 
• Prepare implementation decks and maintain implementation calendar. 
• Mail out greeting cards to patients for special occasions (Birthday, anniversary, etc.).  
• Performs other duties as needed. 

Education and Experience

• Required: high school diploma or GED. 
• Preferred: associate or bachelor’s degree, and some employers may expect this.  
• Preferred: experience in a medical setting and Electronic Medical Record 
• Required: Microsoft Word, Excel, and PowerPoint 

Essential Skills and Abilities

• Self-starter who can work independently and collaboratively, prioritize tasks and has initiative and excitement to take on unfamiliar tasks. 
• Problem solver 
• Collaborates in a professional, empathetic manner with colleagues, 
• Excellent communication and interpersonal skills with the ability to effectively communicate with all levels of management, patients, and family members. 
• Creative, flexible, well organized, resourceful, and detail-oriented 
• Excellent judgment in handling confidential and sensitive information  
• Occasionally required to lift or exert force up to ten (10) pounds
• Working knowledge of company policies, procedures, and operations

Core Competencies

Instills trust Customer focus Manages ambiguity  Collaborates Drives results To ensure the health and safety of our workforce while doing our part to protect those around us, CareConnectMD is requiring proof of full COVID vaccination for employees as a condition of employment, subject to legally recognized accommodations.

The anticipated base pay range for this position is $20-$25 per hour; individual pay is determined by job-related skills, experience, and relevant education or training.

Please send resumes to [email protected] 

Key Duties and Responsibilities 

• Find member populations that are difficult to locate (homeless, severe mental illnesses, substance use, medically underserved, in need of preventive services, etc.)
• Support members in improving their whole health, through outreach and engagement activities, which are primarily field based.
• Enroll members into programs and services by effectively communicating their value.
• Work with members to provide effective and efficient service coordination.
• Collaborates and consults with Nurse Care Manager and/or the Behavioral Health Care Manager on member care issues that is clinical based.
• Provide on-site/in-home member assessments for safety risk, health needs, and barriers to care.
• Develop service plans and guides with members and providers that include health management goals.
• Engage with members, both in-person and on the phone, to achieve health management goals using health coaching, motivational interviewing, and problem-solving techniques.
• Assist members in overcoming any barriers to meeting health goals and update service plans accordingly.
• Assist members in scheduling appointments and accessing community resources.
• Accompany, arrange for, or directly provide, member transportation to health services appointments.
• Follow up with members via phone calls, home visits, and visits to other settings where members can be found.
• Work with social service agencies to arrange to meet other member needs (housing, food, clothing, financial assistance, etc.).
• Work with facilities to help transition members after discharge to a safe home environment.
• Maintain accurate, quality, timely, and consistent documentation in company database of member activities and interventions Achieve set goals/KPI's.
• Continuously expand knowledge of community resources, services, and programs available to members and build ongoing relationships with these organizations to advocate for members.
• Performs other duties as assigned or required to ensure ECM operations are successful. 

Education and Experience: 

• High School Diploma/GED required; bachelor’s degree preferred.
• Community Health Worker Certificate preferred or have at least minimum of 2 years’ experience working in health, social, or community services with ability to attend certification classes. 

Essential Skills and Abilities 

• Knowledge of community resources within the community to be served.
• Represent the company with professionalism by maintaining clear professional boundaries with members and coworkers.
• Working knowledge of social and health issues.
• Ability to quickly establish credibility and trust with patients and build strong relationships.
• Sound judgment and the ability to quickly analyze situations Ability to establish priorities and meet deadlines.
• Ability to problem solve in a proactive, creative manner.
• Cultural competency:
• Able to work with diverse groups of community members Bilingual (Spanish) preferred, but not required.
• Technologically knowledgeable or experienced in note entry systems, smart phones, and laptops.
• Experience providing peer support to patients with complex and multiple chronic conditions and challenging social and mental health conditions (e.g. Community Health Worker, Patient Navigator, In-Home Support Specialist, etc.).
• Training or experience in community health, social determinants of health, and peer counseling.
• Training and experience in using Motivational Interviewing strongly preferred.
• Strong interpersonal and social skills with demonstrated ability to collaborate with a variety of individuals from a wide range of professional and personal backgrounds.
• Knowledge of community-based healthcare and social services systems and the needs of medically underserved populations, and older adults/seniors.
• Ability to thrive in a complex and rapidly changing environment.
• Maintains confidentiality and follows HIPAA standards in safeguarding patient information. Good oral and written communication skills.
• Knowledge and/or experience within Home support Services (IHSS) is highly desirable.
• Life experience overcoming the challenges of chronic disease or work experience with people living with complex chronic conditions is highly desirable. Thrives in an unstructured, start-up environment.
• Self-starter that can work independently and collaboratively, prioritize tasks and has initiative and excitement to take on unfamiliar tasks.
• Excellent communication and interpersonal skills with the ability to effectively communicate with all levels of management, patients, and family members.
• Creative, flexible, well organized, resourceful, and detail oriented.
• Excellent judgment in handling confidential and sensitive information Ability to work independently, set priorities and handle multiple tasks with a high level of efficiency.
• Establishing and maintaining cooperative working relationships with others Core Competencies.
• Instills trust
• Customer focus
• Manages ambiguity
• Collaborates
• Drives results
• $25-$30 per hour

Please send resumes to [email protected] 

Physician - Orange County 

Are you passionate about revolutionizing healthcare for the elderly and medically complex population? If so, CareConnectMD would like to meet you! Since 1996, CareConnectMD (formerly Gerinet Medical Associates) has been providing personalized and compassionate medical care for our frail and medically complex patients in skilled nursing and long-term care facilities. Our 22 years of managing care for high-risk populations has helped us design an integrated care model that effectively coordinates care as our patients transition from inpatient to post-acute settings, including going home. Our unique value-based care model improves clinical outcomes and patient/family satisfaction, while reducing overall system costs. We are experts in symptom management, supportive care, advanced care planning, telemedicine, medical crisis prevention, and patient-family communication. Our Culture: Many employers say they offer work-life balance, but few are able to deliver on that promise. CareConnectMD providers do not practice on a shift-basis, so they have more flexible schedules that work around raising their families and other important priorities. With us, there are no surprise 12-hour work shifts or increasing unpaid time for after-hour clinic work duties. Retention is important to us, so we want to make sure our providers enjoy great qualities of life. CareConnectMD provides after-hours call coverage support, so you can enjoy your time away from work without being interrupted by calls. 

Position Summary:
CareConnectMD physicians will visit a variety of skilled nursing facilities and provide medical management to skilled and custodial nursing patients. Expertise or interest in nursing facility and post-acute care, geriatric and rehabilitation medicine are required. If functioning as Supervising Physician for a clinical team (physician and 1-4 nurse practitioners), the physician will manage the patient census and be responsible for NP direction and supervision, as well as carry out scheduled performance evaluations. Attending physicians will be responsible for periodic night call, as well as rotation on weekend call. Admissions are accepted 24 hours, 7 days a week.

Qualifications: 

• Background in geriatric, rehabilitative and/or internal medicine
• Current State of California medical license
• Current Drug Enforcement Administration (DEA) Certificate
• Current CPR certification
• Medical malpractice insurance policy in force
• Managed care experience preferred Responsibilities:
• Provide physician coverage for a dynamic service area, usually including 8-20 skilled facilities, depending on geographic distance, patient volume, etc.
• Determine and conduct appropriate rounding schedule to accommodate skilled and custodial patient visit requirements.
• Manage medical care of patients on skilled days; ensure adequate visits according to contract requirements and medical necessity; effect safe and timely discharge from skilled level of care.
• Conduct (or delegate, as appropriate) timely monthly visits to all custodial patients in designated service area in accordance with California Title 22 requirements
• Initiate adequate daily communication with Call Center for review and follow-up of non-critical calls, pages, requests for orders, lab results, etc.
• Provide clear direction for nurse callbacks.
• Thorough and accurate medical documentation of all visits using EMR.
• Document/dictate discharge summary in EMR for skilled patients transitioning to care back to PCP.
• Participate in weekend day call and night call (optional)Participate in QI program and Peer Review.
• Participate in utilization management program.
• Attendance at medical staff meetings.
• Active, ongoing patient/family communication.
• Compliance with CPT coding.
• Timely completion of all medical records, sign telephone orders, and charts in accordance with facility and other applicable requirements

Please send resumes to [email protected]

Key Duties and Responsibilities:

• Provides support to the Case Manager and Care Navigator in coordination of patient care.
• Tracks utilization management activities to include updating information on ER visits, hospital admissions, Skilled Part A and B services and Hospice.
• Maintains active and accurate ACO patient census by region, site/location, and providers.
• Maintains updated information in CareConnectMD’s Electronic Medical Record (EMR).
• Runs standard reports including metrics, census, hospitalization, emergency visits, etc.
• Obtains records to include consultation notes, hospitalization and emergency room records, advanced directives, POLST, and other related documents.
• Participates in multidisciplinary team meetings.
• Supports the clinical team with prescription fills, DME, specialist appointments, visit scheduling as needed, transportation and home health arrangements.
• Communicates with patients, responsible parties, and partner facilities including hospitals, long term facilities and hospice.
• Other duties as assigned.

Education and Experience:

• Certified Medical Assistant required.
• Experience in a medical setting is required, a minimum of one year preferred.
• Experience working as part of an interdisciplinary team preferred.
• Experience working with long term facilities and/or inpatient facilities preferred.
• Experience in working with Microsoft Word, Excel, and PowerPoint.
• Experience in working with Electronic Medical Record.

Essential Skills and Abilities

• Self-starter who can work independently and collaboratively, prioritize tasks and has initiative and excitement to take on unfamiliar tasks.
• Problem solver.
• Collaborates in a professional, empathetic manner with colleagues.
• Excellent communication and interpersonal skills with the ability to effectively communicate with all levels of management, patients, and family members.
• Creative, flexible, well organized, resourceful, and detail-oriented.
• Excellent judgment in handling confidential and sensitive information.
• Occasionally required to lift or exert force up to ten (10) pounds.
• Working knowledge of company policies, procedures, and operations.

Licenses/Certifications:

• Certified Medical Assistant or Certified Nursing Assistant

Core Competencies:

• Instills trust
• Customer focus
• Manages ambiguity
• Collaborates
• Drives results To ensure the health and safety of our workforce while doing our part to protect those around us,

CareConnectMD is requiring proof of full COVID vaccination for employees as a condition of employment, subject to legally recognized accommodations. The anticipated base pay range for this position is $20.00 - $25.00. Individual pay is determined by job-related skills, experience, and relevant education or training.

Please send resumes to [email protected]

Leaders thrive with us! HCA Healthcare is one of the nation’s leading providers of healthcare services, comprising of over 180 hospitals and about 2,000 sites of care in 21 states and the United Kingdom. We are looking for a Medical Director for our Mission Health Partners team where excellence creates excellence. Mission Health Partners (MHP) is one of the largest Accountable Care Organizations in North Carolina, with value-based agreements in place with payors that allow MHP to provide care coordination services for at-risk patients under these health plans while also providing incentives for physicians to improve quality and reduce unnecessary costs. The Medical Director works collaboratively with Mission Health Partners (MHP) administrative leadership and clinical staff in the overall clinical management of the network and its care teams. Maintains shared accountability for decisions regarding MHP strategic planning and goals, direction, and development of clinical protocols to assure evidence-based best practices.

What qualifications you will need:

• Required Education: M.D. or D.O. Degree.
• Preferred Education: Master’s degree in Business or Healthcare Administration.
• Required License: Current M.D. license in North Carolina is required.
• Required Memberships: Buncombe County Medical Society Membership is required.
• Required Experience: Ten or more years of demonstrated progressively responsible medical experience. Demonstrated knowledge of the laws and accreditation standards applicable to hospitals is necessary.

Apply Now!

Or you can go to HCAHealthcare.com/careers and search Medical Director in North Carolina on our main website.

This role works with matrix partners across the organization to educate and manage provider performance expectations focused on quality measure outcomes, risk improvement and overall performance to financial targets in Health Partner’s value-based programs. Monitors and shares individual and group performance in regular face-to-face meetings using Key Performance Indicators (KPIs). Engages with providers and office staff to build trust and shift the way providers think about value-based care. Shall promote all clinical programs available as a resource to facilitate full engagement and improve outcomes. Shall play a critical role in fortifying the collaborative relationship we seek to establish with our physicians at the practice level.

Minimum Job Qualifications
Educational Requirements: Bachelor's degree in Business, Healthcare, Information Science, or related field

Minimum Experience:
Minimum of 5+ years experience with increasing responsibilities in developing and executing risk coding programs. Knowledge of, and experience with, utilizing EPIC EHR. Knowledge of, and experience with, health plan value-based arrangements, alternative payment models, healthcare risk quality, and population health outcomes. CRC (Certified Risk Coder) certification (Preferred but not required)Job Specific and Unique Knowledge, Skills and Abilities Experience leading program development and management efforts involving provider/partner engagement and implementation. Experience developing and monitoring delivery of efficient and effective solutions to diverse and complex business problems. Demonstrated ability to embrace and utilize technology and other innovative solutions to deliver enhanced processes and results for provider partners. Expertise in creating training materials and delivering user training. Ability to establish strong relationships and maintain a high level of trust and confidence. Exceptional communication skills, internally and externally, with the ability to convey key messages and influence stakeholders and to convey technical concepts in easily understood ways. Strength in problem-solving based on experience, subject matter expertise, and objective data analysis. Comfortable working on simultaneous and diverse projects and activities. Self-directed, ability to execute projects with minimal supervision. Excellent time management skills with a proven ability to meet deadlines. Ability to work under pressure with urgency and speed while maintaining a high degree of accuracy. Ability to communicate comfortably and effectively at all levels of organization to achieve results. Effective use of Microsoft Office software (Outlook, Excel, PowerPoint and Word). Essential Tasks and Responsibilities Shall develop a comprehensive risk coding accuracy program and curriculum in dyad with matrix partners to include leveraging effective efforts underway within the provider groups Leads collaborative efforts to design and create content-specific internal and external risk adjustment training curriculum and programs Shall set priorities for RA staff in a manner that executes on the right set of initiatives to improve risk scores Shall develop and or identify quality, risk score and financial KPIs that reflect each provider’s contribution towards goals for all contracted payer relationships Shall use dashboards and other reporting tools available from EPIC and or the payers to convey performance trends to providers, groups, and leadership Shall partner with providers and clinical/administrative staff to enhance understanding of clinical documentation improvement goals to achieve risk adjustment strategic goals and objectives Coordinate and deliver programs through flexible approaches including onsite, classroom, remote hosted, and self-service web-based models Design, execute, and report on evaluation methods and key performance indicators to measure results, identify risks/barriers to project rollout, timely deliverables, and adoption success Shall work in close partnership with Health Partners’ care management and quality teams to produce relevant material to share with the providers Shall participate in rolling out new programs and services to providers as they are developed Shall travel to Health Partner provider locations to oversee and execute engagement and shall document all visits in a standard format and retain for future reference Shall create organized presentations and other content to present to various committees and the Board Shall demonstrate the ability to be a strong people performance manager with the ability to motivate staff and drive results Ability to analyze project needs and determine resource requirements to meet objectives and solve problems that span multiple interdisciplinary teams and environments Shall build relationships and communicate with external and internal parties to deliver key messages, influence stakeholders, manage expectations, and shape outcomes

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The Medical Director of Accountable Care is the physician executive for accountable care across Stanford Health Care (SHC) and Stanford Medicine Partners (SMP) and provides medical leadership and direction to the clinical teams responsible for accountable care delivery. This enterprise leader develops innovative care models and clinical interventions focused on management of patient populations and provides oversight of provider performance in achieving value-based care. The Medical Director of Accountable Care works closely with Accountable Care, Quality and Operational leaders to define strategic priorities and goals for Accountable Care, and collaborates closely with medical, operational, finance and quality leadership, to achieve desired outcomes. This leader works within a highly matrixed environment to facilitate awareness and alignment with key leaders, physician groups, individual physicians, and external stakeholders. Reports to Associate Chief Medical Officer for Ambulatory Care. Commitment to effort: 100% FTE

EDUCATION QUALIFICATIONS:
Doctorate required. Candidates may be Physician MD or DO

EXPERIENCE QUALIFICATIONS:

1. At least five years of experience in a similar role, with experience as a leader in a large matrixed organization strongly preferred.
2. Strategic thinking and business acumen with the demonstrated ability to align clinical strategies with business objectives.
3. Operational focus with demonstrated data analysis/interpretation acumen, project management, change management, and execution skills.
4. Extensive knowledge of managed healthcare systems, medical quality assurance, quality improvement and risk management.
5. Track record of successful leadership of case management, disease management, and Accountable Care programs.

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PURPOSE

The ACO Operations Manager will provide day-to-day oversight to Wilmington Health’s client groups participating in the Accountable Care Organizations associated with Wilmington Health’s Management Services Organization (MSO), Block Ops. This position will facilitate and support program governance, operations and communication strategies for our MSO ACOs which includes the development and maintenance of project plans, quality initiatives, cost containment, and patient experience initiatives.

Essential Duties/Responsibilities

Maintains knowledge regarding ACO policies and procedures, governance structure and regulatory requirements through ongoing research and regular attendance at training webinars. Utilizes standard project management tools and principles to define and manage project scope, monitor timelines and deliverables, and communicate and identify pathways to resolve risks and barriers. Oversees and maintains effective communication with stakeholders using communication plans, status reports, dashboard and various media sources tailored to the audience. Effectively plans and facilitates meetings of varied participants using standard meeting management tools and techniques (e.g. agendas, meeting roles, ground rules, minutes, action item tracking) including support of meeting logistics for ACO Boards and committees. Leads process improvement, new workflow development, enhancement through support of and collaboration with practices to drive performance on contract quality and equity metrics. Works collaboratively with practices and providers to develop campaigns to address gaps in care, monitors patient and practice/provider compliance with campaigns and provide feedback and adjustment as needed to ensure success. Leads planning efforts to enable the Block Ops team to effectively achieve high performance in risk-based contract quality and equity metrics and ensure compliance with regulatory agencies. In collaboration with the WH ACO and analytics teams, develops comprehensive operation for clinical data acquisition, reporting, and workflow development in support of quality measure improvement. In collaboration with local leaders, informs the redesign of local workflows to drive performance in quality and equity metrics. The Compliance Officer will create, maintain, and audit the ACO’s Compliance Plan and provide regular reports to the Governing Body of the ACO. Establish and maintain a method for employees or contractors of the ACO, its ACO Participant Provider and Preferred Providers, and other individuals or entities performing functions or services related to ACO Activities or Marketing Activities to anonymously report suspected problems. Work with the Wilmington Health Compliance Officer to receive claims analysis to identify potential fraudulent behavior or program integrity risks, such as inappropriate reductions in care, effort to manipulate risk score or aligned populations, overutilization, and cost-shifting to other payers or populations. Audit chart, medical records, Implementation Plans and other data from the ACO, its ACO Participant Providers and its Preferred Providers. Cooperate with all CMS monitoring and oversight requests and activities. Ensure compliance with all applicable state licensure requirements regarding risk-bearing entities in each state in which the ACO operates. In a form and manner and by a deadline specified by CMS, the ACO shall submit to CMS documentation demonstrating its compliance with the requirement set forth in the Agreement. Ensure compliance with all plans submitted to CMS for benefit enhancements or waivers. Ensure that the ACO has appropriate procedures in place to ensure that ACO Participant Provider and Preferred Providers have access to the most up-to-date information regarding Beneficiary alignment to the ACO.

QUALIFICATIONS

Required: 3+ years’ experience in healthcare, with value-based care models (CMS MSSP, ACO REACH, Commercial full or partial risk contracts).Demonstrated understanding of healthcare clinic models, HEDIS measures, STAR ratings, documentation processes, and strategies to close gaps in care and support caring for high and rising risk patients with multiple chronic conditions. Strong expertise with MS Excel, MS Teams, and PowerPoint. Preferred: 5+ years’ in healthcare operational management Demonstrated understanding and experience with SQL queries and analytics, understanding of risk stratification models, and the ability to translated data-driven insights into clear clinical priorities and interventions. Bachelor’s Degree in Healthcare or Business Administration.

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The CareNu Senior Accountant is responsible for implementing and maintaining accounting processes and records; performing analysis of source transaction files, data, and documentation; and preparing journal entries, reconciliations, financial statements, and pro forma financial reports.

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This role works with matrix partners across the organization to educate and manage provider performance expectations focused on quality measure outcomes, risk improvement and overall performance to financial targets in Health Partner’s value-based programs. Monitors and shares individual and group performance in regular face-to-face meetings using Key Performance Indicators (KPIs). Engages with providers and office staff to build trust and shift the way providers think about value-based care. Shall promote all clinical programs available as a resource to facilitate full engagement and improve outcomes. Shall play a critical role in fortifying the collaborative relationship we seek to establish with our physicians at the practice level.

Minimum Job Qualifications

• Licensure or other certifications:
• CRC (Certified Risk Coder) certification.

Educational Requirements

• Bachelor's degree in Business, Healthcare, Information Science, or related field

Minimum Experience

• Minimum of 5+ years experience with increasing responsibilities in developing and executing risk coding programs.
• Knowledge of, and experience with, utilizing EPIC EHR.
• Knowledge of, and experience with, health plan value-based arrangements, alternative payment models, healthcare risk quality, and population health outcomes.

Apply Now!