Job Summary: Is responsible for the ongoing management of Florida Medical Clinic’s Accountable Care Organization (ACO) CMS, recognizing the connection between price, cost and value with a focus on quality and reducing the total cost of care.
Is knowledgeable of all program requirements as described in regulations and by CMS and ensures all requirements of the program are met.
While the Director of Accountable Care Services has no line responsibility to operations or finance, the incumbent will work collaboratively with all departments to influence the changes needed to make Accountable Care successful.
Essential Functions of the Position:
- Executes the strategies related to the development and management of the ACO to include:
- Clinical programs (preventive, outreach and clinical care delivery)
- Analyzes data to identify gaps in care
- Oversees beneficiary outreach program regarding preventive services and care gaps
- Clinical integration programs and processes
- Improves access to care
- Promotes patient-centeredness
- Promotes efficient and cost-effective delivery of care
- Care management and coordination programs and processes (IPA and ACO)
- Identifies high risk patients and develops and implements appropriate care planning and care management activities
- Identifies patients with selected chronic diseases and develops and implements appropriate care planning and care management activities
- Promotes self-care management through health promotion and education
- Oversees the coordination and follow up of inpatient activities
- Coordination of care between hospitalists, specialists and PCPs
- Discharge planning
- Post discharge follow-up
- Medication reconciliation
- Supervises the mid-level providers working in the ACO
- Is responsible for the data abstraction process and the accurate and timely reporting of quality measures to CMS through the GPRO Web Interface
- Ensures all requirements of the program are met, including but not limited to: beneficiary notification; beneficiary preference data base; required office postings; periodic certification with CMS, and public reporting.
- Analyzes data to identify population health needs and implements population programs for ACO beneficiaries
- Coordinates with IT regarding the transfer of CMS data files
- Coordinates the functions of the ACO Board of Directors, and provides feedback to the ACO Board of Directors, ACO participants and senior management regarding ACO provider performance
- Works with the Medical Director to oversee and manage the ACO-related Committee meetings (Community Relations Committee and Utilization Management Committee) and provider office meetings and ACO team meetings
- Is a contributing member of the Quality and Performance Measurement Committee and Compliance Team related to the ACO function and responsibility
- Performs other incidental and related duties as required and assigned.
Physical and Mental Demands:
- Routine desk and office activities
- Ability to move frequently throughout the facility and to sit for long periods of time
- High concentration and high complexity of decision making
- High level verbal and written communication skills
- Above average ability to manage multiple tasks and projects simultaneously
- Low risk exposure to bloodborne pathogens and chemical hazards.
- RN with valid Florida license, bachelors degree preferred
- Utilization Management/Quality Management experience/ CPHQ certification preferred
- Minimum of five years of management experience in a health care organization
- Knowledge of CMS ACO requirements and quality measures
- Ability to work effectively with physicians
- Ability to influence change
- Knowledge of quality improvement processes
- Knowledge of regulatory and accreditation requirements
- Excellent communication and problem solving skills
- Strong customer service orientation
- Demonstrated leadership ability