As a part of the Tenet and Catholic Health Initiatives family, Conifer Health brings 30 years of healthcare industry expertise to clients in more than 135 local regions nationwide. We help our clients strengthen their financial and clinical performance, serve their communities and succeed at the business of healthcare. Conifer Health helps organizations transition from volume to value-based care, enhance the consumer and patient healthcare experience and improve quality, cost and access to healthcare. Are you ready to be part of our solutions? Welcome to the company that gives you the resources and incentives to redefine healthcare services, with a competitive benefits package and leadership to take your career to the next step!
The Senior Director is responsible for overall leadership, strategic direction and delivery of Conifer Value-Based Care Medical Management programs. This role will be a spokesperson for the clinical department and ensure the goals of the medical management programs are achieved. This role also provides operational leadership and overall strategic direction for Medical Management initiatives and outcomes, including development of new programs based on client and/or strategic needs.
The Senior Director is responsible for directing and overseeing an efficient and seamless operations for all aspects of current and future medical management programs. Working within and across departments, the Senior Director drives continuous improvement in operational efficiency and internal processes. The Senior Director oversees and reports on outcomes delivered by team. The Senior Director ensures medical maangement programs meet or exceed internal, regulatory, and industry standards.
The Senior Director will inspire a large team to improve member and client outcomes. The Senior Director will represent the clinical team internally and externally to stakeholders, clients, prospects and regulatory bodies.
ESSENTIAL DUTIES AND RESPONSIBILITIES
Include the following. Others may be assigned.
Monitors, evaluates, and redesigns program practices and processes to meet or exceed all regulatory, accrediting agency, and client requirements
Oversees the day to day operations of the Medical Management Program linking respective business operations / business strategy with financial results. Additionally will work with Client Delivery to ensure that established clients goals, aligned with Medical Management, are met
Provides leadership in developing and implementing care management programs and initiatives to achieve overall program goals and identifies areas of risk and opportunities to enhance business models. Oversees the development of process, policies and practices to maximize the value of the medical management program. These include: product , compliance, quality, operations, and client teams
Serves as the clinical leader to prospects, clients, health plans, and regulatory bodies
Oversees and is accountable for medical management audit results and corrective action plans, in coordination with regulatory and compliance teams
Inspires, develops, and coaches team members to achieve development goals and build skills. Proactively communicates and engages across all levels of organization
If direct report positions are listed below, the following responsibilities will be performed in accordance with guidelines, policies and procedures and applicable laws. Supervisory responsibilities include interviewing, hiring, and training employees; planning, assigning and directing work; appraising performance; rewarding and disciplining employees; addressing complaints and resolving problems.
Direct Reports (titles) Directors Population Health / Medical Medical Management
Indirect Reports (titles) Managers
KNOWLEDGE, SKILLS, ABILITIES
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Knowledge of Medical Management regulations that fall under CMS, URAC, NCQA, and other applicable state and accreditation standards.
Commitment to service excellence and member satisfaction.
Ability to develop and maintain effective working relationships with other teammates, members and clients.
Ability to multi-task in a fast-paced clinical setting.
Excellent verbal, written and interpersonal communication skills.
Ability to relate to culturally diverse patients and community.
Ability to develop positive interaction with patients, families, physicians, administrators and teammates in order to effectively care for the patient.
Aptitude for coaching, training and developing new teammates.
Ability to build strong relationships across multiple functional lanes.
Ability to analyze and interpret data to show outcomes and/or focus area for improvement
Strong communication, team leadership and project management skills.
Ability to collaborate and build strong client relationships across all levels of the organization including clinical staff, physicians and administrative leadership to meet deliverables.
Conifer requires its candidates, as applicable and as permitted by law, to obtain and provide confirmation of all required vaccinations and screenings prior to the start of employment. This may include, but is not limited to, the COVID-19 vaccination, influenza vaccination, and/or any future required vaccines and screenings.
EDUCATION / EXPERIENCE
Include minimum education, technical training, and/or experience preferred to perform the job.
10+ years of professional experience required; minimum 10 years experience overseeing medical management operations for health plan, management services organization, and/or health plan.
Externsive utilization management (prior authorization / concurrent review) and case management experience
Extensive experience managing budget of $5M+ with demonstrated ability to drive productivity and outcomes
Demonstrated experience designing and implementing new programs
Experience in business-to-business client service organization preferred
Experience providing strategic leadership, managing teams and leading projects required.
At least 5 years management experience with large, geographically disparate teams
Include minimum certification required to perform the job.
Bachelorâ��s degree from a four-year college and/or a professional certification requiring formal education beyond a two-year college.
Case Management certification preferred
Active RN or MD License
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Must be able to work in sitting position, use computer and answer telephone
Ability to travel
Includes ability to walk through hospital-based departments across broad campus settings, including Emergency Department environments
The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Office Work Environment
Approximately 50% travel may be required
Job: Conifer Health Solutions
Primary Location: Frisco, Texas
Job Type: Full-time
Shift Type: Days
Employment practices will not be influenced or affected by an applicantâ��s or employeeâ��s race, color, religion, sex (including pregnancy), national origin, age, disability, genetic information, sexual orientation, gender identity or expression, veteran status or any other legally protected status. Tenet will make reasonable accommodations for qualified individuals with disabilities unless doing so would result in an undue hardship.
Tenet Healthcare Corporation (NYSE: THC) is a diversified healthcare services company headquartered in Dallas with 112,000 employees. Through an expansive care network that includes United Surgical Partners International, we operate 65 hospitals and approximately 510 other healthcare facilities, including surgical hospitals, ambulatory surgery centers, urgent care and imaging centers and other care sites and clinics. We also operate Conifer Health Solutions, which provides revenue cycle management and value-based care services to hospitals, health systems, physician practices, employers and other clients. Across the Tenet enterprise, we are united by our mission to deliver quality, compassionate care in the communities we serve.