Director Clinical Programs

Join Martin's Point Health Care - an innovative, not-for-profit health care organization offering care and coverage to the people of Maine and beyond.  As a joined force of "people caring for people," Martin's Point employees are on a mission to transform our health care system while creating a healthier community.  Martin's Point employees enjoy an organizational culture of trust and respect, where our values - taking care of ourselves and others, continuous learning, helping each other, and having fun - are brought to life every day.  Join us and find out for yourself why Martin's Point has been certified as a "Great Place to Work" since 2015.
 

Position Summary
 

The Director of Health Plan Clinical Programs provides strategy and program development for clinically and financially successful Utilization and Care Management programs for Senior and Military family populations. This person will work closely with the Health Plan Clinical leadership team and provide oversight and coordination of a team providing care management related activities and will monitor clinical and financial outcomes for the Martin’s Point Health Plan. The Director will work closely with VP of Health Plan Clinical Program and the Health Plan Medical Director to ensure the clinical departments can support enterprise-level growth, CMS STARS performance, clinical outcomes, and medical trend targets. This includes creating new or redesigning existing product programs to achieve the triple aim.

The Director will lead a team to execute on program strategy, design and implementation through project management, and the ability to foster support for program enhancements across all levels of the organization. Partnering with all Health Plan and shared service departments, the Clinical Programs Director will support the above through coordination of government and regulatory affairs, industry best practices and innovation, national evidence-based medicine guidelines, population health strategies and clinical integration.

Job Description

Key Outcomes:

• Implements of new programs and services to meet population health needs including activities to manage medical costs with focus on health outcomes.
• Develops objectives across the department to ensure compliance with professional and regulatory standards, federal contracts, and accreditation standards.
• Develops and leads high performing care management activities to reduce cost per capita for all member populations while ensuring members receive high value care and support in the healthcare system for optimal health outcomes.
• Leads complex care and care management activities for Martin’s Point to improve clinical and medical trend outcomes. Determines needs for specific disease programs and implementation, such as CHF.
• Oversees operational and outcome reporting to monitor the progress and outcomes of all care management and disease management activities carried out by the department including reporting to regulatory and accrediting agencies.
• Manages relationships and coordination with external vendors and delegated entities. Responsible for Delegation Oversight of Clinical vendors
• Develops and manages Key Performance Indicators (KPIs) for care management and disease management.
• Partners with cross functional teams to successfully enhance existing clinical program’s structure to address the needs of members, support the work of care teams, promote high STAR performance and align with our company objectives.
• Ensures all program design and redesigns are in compliance with professional and regulatory standards, federal contracts, and accreditation standards.
• Collaborates across health plan clinical programs as well as other key health plan departments and the delivery system to ensure alignment of clinical and operational initiatives and activities.
• Collaborates with the Director Health Plan Quality to support initiatives such as HEDIS, Member Safety, QIPs, QII’s, CMS Stars and accreditation.
• Collaborates with clinical teams across Health Management synthesizing clinical outcome drivers and quality/operati