Senior Director, Population Health

United States

Job Description

Leads, designs, implements and operates all aspects of the population health, chronic condition management programs for Magellan Complete Care. This includes new health plan implementations, program development, system migration, operations improvement, and quality improvement activities. Supervises/manages the clinical team population health staff. Collaborates with other members of the Magellan Complete Care (MCC) Clinical team and market-based department leads to design, develop, implement, and ensure the fidelity of the foundational and market and product specific clinical, quality, and population health/chronic condition management, care coordination/care management programs, processes, systems, and reporting integration.

Collaborates with the local markets and product areas with implementation and daily operation ensuring that the clinical programs, activities, and reporting and system requirements meet the standards required for State, NCQA and URAC, CMS and other accreditation and oversight entities. Leads, directs, coordinates and evaluates efficiency and productivity of the population health staff and clinical program functions, including, benefit management, chronic condition management programs, digital, telehealth/telemedicine and health promotion across populations.

Essential Functions

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  • Provides oversight of the total population health program including, care management, referral management, disease management and quality program functions serving both the Medicare and Medicaid populations for health plans.
  • Provides organizational leadership and oversight of population health tools, workflow design, outcome metrics, along with financial and quality performance.
  • Works closely with and supervises/manages designated national team staff and collaborates with other members of the National MCC leadership team to design, develop, implement, and ensure the fidelity of the foundational and market and product specific clinical, quality, and care coordination programs, processes, systems, and reporting integration. 
  • Collaborates/assists the local markets and product areas with implementation of the clinical model and programs and ensures that the clinical programs, activities, and reporting and system requirements meet the standards required for State, NCQA and URAC, CMS and other accreditation and oversight entities.
  • Leads, directs, coordinates and evaluates efficiency and productivity of the care coordination and clinical program functions, including utilization review, benefit management, complex case management, chronic disease programs, and health promotion across populations. 
  • Collaborates with market-based clinical leaders to ensure alignment with population health management goals
  • Participates in the evaluation of the clinical model and programs against quality and utilization benchmarks and goals.  Identifies opportunities for improvement.
  • Works closely with and supervises/manages designated national team staff  and collaborates with other members of the National MCC leadership team to design, develop, implement, and ensure the fidelity of the foundational and market and product specific clinical, quality, and care coordination programs, processes, systems, and reporting integration. 
  • Assists the local markets and product areas with implementation of the clinical model and programs and ensures that the clinical programs, activities, and reporting and system requirements meet the standards required for State, NCQA and URAC, CMS and other accreditation and oversight entities.
  • Leads, directs, coordinates and evaluates efficiency and productivity of the care coordination and clinical program functions, including utilization review, benefit management, complex case management, chronic disease programs, and health promotion across populations. 
  • Participates in the evaluation of the clinical model and programs against quality and utilization benchmarks and goals.  Identifies opportunities for improvement.
  • Ensures and participates in staff selection, training, and evaluation promoting the development of high quality teams.
  • Builds clinical programs to improve both quality of care and care coordination thereby reducing cost due to wasted and ineffective care
  • Establishes KPI’s for various population health functions within the organization consistent with industry benchmarks, with the objective of improving quality and reducing the cost of care
  • Operationalizes practice adoption of member engagement strategies around chronic condition prevalence to support providers in delivering high quality care at a lower total cost
  • Evaluates and determines staffing needs to address both the clinical and social needs of local plan membership, including ensuring training and development meets the current and anticipated delivery needs of membership.

General Job Information

Title

Senior Director , Population Health

Grade

31

Job Family

Quality Group

Country

United States of America

FLSA Status

United States of America (Exempt)

Recruiting Start Date

3/22/2019

Date Requisition Created

3/11/2019

Minimum Qualifications

Education

Bachelors: Nursing (Required), Masters: Nursing

License and Certifications - Required

APRN,BC - Advanced Practice Registered Nurse, Board Certified - Care Mgmt, RN - Registered Nurse, State and/or Compact State Licensure - Care Mgmt

License and Certifications - Preferred

Other Job Requirements

Responsibilities

  • Bachelors and Masters required in Nursing
  • APRN or BSN-RN
  • 7+ years of experience in healthcare managed care; health plan/MSO clinical operations (including care management, utilization management, and health analytics/reporting) is required
  • 5+ years leadership experience
  • Knowledge of NCQA and Medicare regulatory requirements
  • Microsoft Office proficiency
  • Experience in the coordination and collaboration of work teams and a proven track record of success while working in any of the following functional areas: Product Management and Development or Program Operations
  • Proven track record of results
  • Experience in the design, management, and implementation of products including the coordination and integration of all primary business functions
  • Must possess strong organizational, consultation, analytical, verbal and written communication skills
  • Strong organizational and consultation skills in the areas of product development and analysis
  • Self-starter and ability to work independently
  • Must be able to adhere to strict deadlines
  • Thorough knowledge of the healthcare industry, including PBM and Specialty Pharmacy
  • Comprehensive understanding of specialty product implementation and client needs/wants to creatively recommend product and services that is market competitive while meeting financial goals of the company
  • Knowledge of Specialty Pharmacy and overall strategies to pull through scripts
  • Knowledge of underwriting principles and guidelines

Magellan Health Services is proud to be an Equal Opportunity Employer and a Tobacco-free workplace. EOE/M/F/Vet/Disabled

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