Executive Director, Market

Duties And Responsibilities

• Provide daily leadership and management of market operations which includes, but is not limited to, Utilization Management, Care Management, Immediate Care Area, Primary Care Program, Behavioral Health, and Community Based Providers and Community Care Teams
• Responsible for the financial and clinical performance of the market along with the Medical Director with the goal of meeting or exceeding target EBITDA
• Work closely with administrative and clinical team members to ensure that members (patients) are receiving high quality care and that the staff are motivated to deliver an exceptional member experience
• Collaborate with a team of national subject matter experts (SME) within nursing, care management, behavioral health, HIV, nursing, and pharmacy disciplines to ensure that the market is delivering value and a positive member experience
• Direct management and oversight of the following Direct Reports: CCM/UM Manager, Engagement Manager, Practice Manager, and Clinical Nurse Manager
• Responsible for meeting various key performance indicators, including, but not limited to: call answer rate, HR turnover metrics for center-based teams, transportation spend, employee engagement scores, and clinical/quality scores for PCP members, utilization management (bed days), total medical expenditure (PMPM), and overall financial performance of the market
• Lead or delegate New Hire Experience every other week and will also be responsible for hiring, orienting, training, counseling, disciplining, direct support staff
• Prepares and leads the team through Monthly Operating Review (MOR) meetings and highlights programmatic strengths and opportunities and follows up on initiatives that enhance performance across the board
• Collaborates with finance around annual budget process and works to finalize staffing model and growth projections to ensure market success
• Responsible for market planning around quality events, employee recognition events, and for building relationships with community partners
• Partners with pharmacy leadership team to ensure optimal patient care delivery of medications to our membership
• Communicates with our shared services team around FQHC partnerships and payor relations and takes lead on projects as needed
• Responsible for office compliance and quality assurance that includes staff education, auditing, and routine monitoring as well as adherence to office policies and procedures for the following: State or federal standards and guidelines pertaining to the medical practice, and corresponding licensure, Billing, coding, and fraud waste and abuse compliance, Financial transactions of the medical practice and pharmacy, OSHA, infection control and staff safety (shared responsibility), HIPAA privacy & security, Management of liability risk, Patient safety, CLIA certification, Radiology certification and radiation safety standards, Implement and evaluate policy, procedure, and program content. Routinely conduct quality assurance activities through reviews, meetings, reports, and observation of results, according to professional practice standards and regulatory compliance
• Evaluate and monitor program needs, identifies unmet needs and systematically addresses need for change
• Collaborate with the compliance team to ensure applicable practice, federal and state standards are met
• Conduct fact-finding investigation of patient and family grievances or complaints and acts as indicated within scope of authority
• Lead weekly leadership team meetings and prepares agenda as well as brings in SME’s as warranted
• Direct staff participation in fire drills and disaster evacuations
• Oversee local facilities management and security of care center
• Promote AbsoluteCare’s core values and help promote and drive positive quality metrics
• Work with the national team to develop a payer account management strategy that includes growing same store membership, expanding product/programs, maximizing quality and risk pool payments and other operating metrics, maintaining best in market relationships, and securing new payer relationships

Minimum Qualifications

• Bachelor’s degree
• Minimum 10 years of practice management experience
• 3-5 years’ experience in medical office supervision and management
• Clinical background is a plus (LPN, RN, NP)
• Master’s degree (MBA, MHA) preferred but not required
• Excellent critical reasoning, decision-making, and problem-solving skills to analyze situations, determine risks, and find solutions to prevent future issues and resolve recurring defects
• Strong organizational skills and attention to details to handle multiple tasks, short deadlines, frequent interruptions, and shifting priorities in support of changing company objectives
• Excellent interpersonal communication skills
• Previous experience working in healthcare or healthcare-related fields
• Experience and understanding of managed care quality metrics/HEDIS preferred
• Understanding and experience with the Patient Centered Medical Home (PCMH) and Accountable Care Organization (ACO) medical models preferred
• An understanding and an interest in improving Population Health and associated initiatives
• Previous experience using different Electronic Medical Records and experience utilizing and leveraging reporting capabilities/technology in order to improve clinical efficiencies
• Excellent computer skills including knowledge of Microsoft Word, PowerPoint, Excel, and different databases
• Knowledge of medical billing rules and regulations and software applications
• Excellent organizational skills, ability to multi-task, self-motivated and able to work in a fast-paced environment
• Knowledge and experience with medical billing and coding