Company Statement

ConnectiCare is a leading health plan in the state of Connecticut.  ConnectiCare’s mission is to make it easy for members to get the care they need. A local company for over 35 years, ConnectiCare has a full range of products and services for businesses, municipalities, individuals and those who are Medicare-eligible. A subsidiary of EmblemHealth, ConnectiCare leads the individual and small group markets in the state, and is ranked among the top commercial health plans in the nation, according to the National Committee for Quality Assurance.


We’re looking for individuals who want to make a difference in the communities we serve. If you want to join a local team and help change the way health care is delivered, ConnectiCare is the place for you.

Director, Clinical Operations

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Healthcare Operations
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ConnectiCare
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Summary: Transform and integrate care and utilization management to a holistic model of care, characterized by multi-disciplinary and provider collaboration alignment, innovative clinical programs and practices to achieve the triple aim, through collaboration with physicians. Champion for strong and effective foundational relationships across the enterprise.

Responsibiliities

•Creates and manages performance-based Clinical Operations teams to maximize the business results of Healthcare Management.

•Act as a clinical operations subject matter expert for commercial and Medicare products.

•With leadership, establishes best practice for ensuring operational control with an effective process for monitoring critical performance metrics to assure compliance with Medicare Advantage program and/or NCQA standards, as well as state and federal regulatory requirements.

•As applicable, works internally and in tandem with Provider Collaboratives and outsourced vendors, to identify and implement integrated care coordination and population health management strategies that maximize all available skills and resources to improve members� health care experience, reduce medical expense and improve quality outcomes.

•Provides direction, leadership, evaluation, and development of staff. Ensures that a high performing work culture is embedded within the departments.

•Assures department workflows and policies/desktop procedures are aligned and accurate at all times.

•Identifies, obtains and processes critical data (e.g. benchmarks) to challenge the status quo through innovative thought leadership and application of industry-specific solutions for managing high-performance teams.

•Works directly with CMO and other VPs to drive the strategic direction and innovation agenda to improve the holistic population health management experience.

•Collaborates with others to establish transformative and innovative population health management.

•Works in close partnership with leadership to establish relevant reporting of programs and initiatives.

•Provides clinical and workflow management oversight direction for design, development, testing and implementation of software applications used to support Clinical Operations.

•Drives to raise the bar in outcomes by partnering and developing the skills and medical management capabilities of physician organizations and partnerships. Cultivates cooperative relationships with their respective organizations through partnership with key clinical business partners, designed to improve the quality and cost-effectiveness of care delivered to members.

•Supports sales and marketing efforts, including the development of and presentations to employer customers.

•Supports the Quality and Pharmacy departments to sustain HEDIS STARS.

•Participates in Network optimization with physician collaboratives sharing data elements for focused efforts in driving quality improvement outcomes.

•Performs other related projects and duties as assigned.

Qualifications:
•RN, licensed in Connecticut. Bachelor�s Degree in Nursing or an equivalent combination of education and experience preferred
• Master�s Degree in a relevant field is preferred
• At least 7 years of clinical and disease management experience
• Demonstrated success in achieving and sustaining high levels of NCQA accreditation in Managed Care and/or Disease Management and regulatory compliance with Medicare Advantage regulations is preferred
• Accountable Care Organization experience preferred
• At least 5 years of demonstrated successful managerial experience with ability to work in a matrix management environment
• Computer literacy (Microsoft Word, Excel, PowerPoint, and Access) required as it relates to the ability to manipulate and analyze data

Essential Job Requirements:
• Primarily sedentary
• Must be able to use standard office equipment

EEOC Statement

We are committed to leveraging the diverse backgrounds, perspectives and experiences of our workforce to create opportunities for our people and our business. We are an equal opportunity/affirmative action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, protected veteran status or any other characteristic protected by law.

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