Director, Clinical Operations

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OVERVIEW OF POSITION:
The Director, Clinical Operations (Director) is accountable for all facets of clinical operations for the Regional Accountable Entity (RAE) contract held by Colorado Community Health Alliance (CCHA) with the Colorado Department of Health Care Policy & Financing (HCPF). Reporting to the Vice President, CCHA, with matrixed reporting to the Program Officer, the Director will provide subject matter expertise on care navigation, coordination and management for Health First Colorado (Colorado’s Medicaid Program) members.

The Director will oversee Care Coordination, Navigation and Management services. This role is accountable for meeting all care coordination and member navigation expectations in the contract, including inbound and outbound call volume service line agreements and member satisfaction. The Director will work closely with the Performance and Data team to measure and scale care management programs and outcomes. The Director will lead with efficiency and clinical best practices in mind while ensuring the delivery of patient- and family-centered services and support.

The position may include evening hours and travel throughout the eight-county service area of CCHA.

• Provides leadership and direction on care navigation, coordination and management program design
• Serves in the capacity of Director of Care Coordination
• Key Personnel for the state contract
• Utilizes outcomes data to inform the development of care and condition management programs
• Creates proactive processes and policies to prevent the exacerbation of Member conditions and the escalation of Member situations
• Partners with Chief Clinical Officer, subject matter experts, and business owners as well as joint venture care coordination, utilization management, Chief Behavioral Health Officer and quality partners to achieve on care coordination and call center expectations as outline in ACC Phase III
• Participates in clinically focused calls, work groups and meetings with internal and external entities
• Leads team employee engagement efforts as well as serves as a champion for the organization’s mission, vision, and values
• Facilitates effective communication, collaboration, and coordination between CCHA and, at a minimum, partner Case Management Agencies, Behavioral Health Administrative Services Organizations, and Dual Special Needs with the goal of ensuring comprehensive, effective and efficient coordination of care for jointly managed Medicaid Members
• Jointly oversees effective delivery of Care Coordination for Members by Network Providers, delegated and Subcontracted organizations, and others within the Health Neighborhood in collaboration with the Performance and Data team
• Adapts, develops and/or revises policies and procedures and promote their implementation across the organization
• Partners with joint venture and internal clinical leaders to develop and implement a care coordination model drive by a risk stratification methodology that aligns with the state tiers in ACC Phase III
• Works across teams to develop clinical programs that improve performance on ACC Phase III quality program measures
• Oversees the creation and provision of care coordination training and best practice delivery to delegated care coordination entities
• Responsible for oversight to ensure all clinical, care coordination and call center contractual requirements are delivered to the state on time and in a consistent and accurate manner
• Works with joint venture partner to meet RAE contract requirements and ensure…