Senior Director of Care Management

Reporting to the Tufts Medicine Integrated Network (TMIN) Vice President of Performance Management, this role serves in a broad range of functions to drive care management programs and services for at-risk patients including chronic and complex care management, and value-based care delivery across the post-acute network and in alignment with the acute care setting. This includes care management program planning, coordination, implementation, management, and evaluation of the effectiveness of programs developed and provided to serve TMIN member providers and their patients.

TMIN’s complex value-based care positions require a strong Senior Director of Care Management to innovate in care delivery and design leading programs and interventions to improve care and meet contractual obligations.  Distribution of Job Duties:  30% Tactical, 40% Operational, 30% Strategic.

Responsibilities

• Tactical Duties:  Ensure appropriate staffing and daily team management responsibilities
• Operational Duties:  Manages budget, process improvement, and works with regions and Tufts Medicine stakeholders to develop workflows and process to support patient care
• Strategic Duties:  Develops and reviews goals to meet overall patient care and organizational objectives
• The TMIN Senior Director of Care Management is directly responsible for:

• Primary responsibilities
• Serves as a key member of the TMIN strategic operations team, works collaboratively and provides critical input into the development of the TMIN clinical strategy and annual quality and performance plans
• Develops, implements and oversee execution of ongoing care management programs and services for the TMIN
• Develops and oversees reportable metrics to demonstrate outcomes for the programs and initiatives, tracks trends and monitors performance goals and progress
• Establishes continuous cycles of improvement for network programs
• Collaborates closely with clinical and other department leaders
• Serves as a liaison including LCO management, physicians, other providers, vendors, community hospitals and other partner organizations
• Serves as a liaison to various payers including Medicare Shared Savings Program (MSSP), Medicare Advantage programs (Tufts Medicare Preferred, United HealthCare, BCBSMA) and local and national commercial insurers. 
• Accountable for ensuring quality and outcomes of the care management programs across the network serve as a value-add to all practice members
• Oversee a diverse team of NPs, RNs, CHW, Navigators and more across the post-acute network with ongoing management responsibilities and oversight of regional teams
• Collaborate and align with community partners across the network
• Represent team at all Mass Health required meetings to be the leadership voice of the programs providing consistent and collaborative feedback to Executive Office of Health and Human Services
• Collaborate closely with the acute case management teams to align workflows and resources to best support patients and families
• Maintains current working knowledge of evidence-based practices, Medicare/Medicaid rules and regulations regarding documentation and case management activities
• Works with the Chief Medical Officers, Medical Directors, and others as needed to effectively support and facilitate, as assigned, key TMIN meetings and serves as a key contributor on various committees as needed
• Other duties as assigned

Experience

• Education Preferred: Master’s degree in Healthcare Administration, Nursing or related field
• Requires 15 years of care management program delivery and value-based care knowledge and experience
• Registered nurse with an active professional Massachusetts license
• Broad knowledge and experience with value-based contracting, payer relationships and upside and downside risk mitigation
• Broad knowledge and competency in Electronic Health Records, Epic preferred
• Workflow knowledge in ambulatory care / provider practice settings
• Demonstrated project management experience in healthcare setting, ambulatory care preferred
• Demonstrated understanding and application of communication and change management techniques
• Establishes good working relationships with physicians and practice staff
• Demonstrates skills, knowledge and abilities for pilots, programs and projects from conception to implementation
• Excellent written and oral communication skills
• Professional experience working in an integrated care delivery system
• Experience working with information systems technology
• Experience in developing collaborative relationships with community healthcare partners