AVP, Clinical Implementation - Remote

Summary of Position

• Provide overall strategic, clinical, and operations management with direct accountability for all [(1) Medicare, DSNP and
Commercial or (2) Medicaid, HARP, Essential Plan] lines of business.
• Responsible for all clinical programming compliance requirements.
• Responsible for the clinical partnership with various care management vendors impacting the care delivery.
• Direct and lead large multidisciplinary clinical care management teams addressing a wide range of health concerns and
inclusive of programs such as complex case management, transition of care, disease management and behavioral health care
management.
• Responsible for planning, organizing, and directing the administration of all Care Management Programs.
• Develop and coordinates care management strategies for ensuring the delivery of care in the most appropriate setting.
• Lead the implementation of improved clinical care management models and collaborations to decrease preventable
admissions, and readmission.

Principal Accountabilities

• Direct, plan and implement large, complex initiatives across a broad clinical team.
• Set and execute successful clinical growth strategies.
• Establish budgets and prepare/execute strategic plans.
• Provide expert knowledge and thought to leadership to develop and manage all clinical programming.
• Serve as point person for the launch of new programs based on company-wide goals or pilot projects.
• Lead the clinical team in the planning, development, and implementation of clinical operations that deliver care that is
timely, safe, effective, efficient, equitable, and in alignment EmblemHealth’s mission to provide for quality healthcare.
• Accountable for delivering on contract and programmatic performance metrics across all payor classes (Public and
Private) and clinical programs.
• Oversee Quality Assurance/Performance Improvement activities across Medicare/State Sponsored/Commercial.
• Work in close collaboration with compliance staff to ensure that clinical services, documentation, training, and
supervision meet regulatory requirements.
• Manage a team of staff at all levels, including the developing and implementation of Key Performance Indicators and
Milestones for tracking productivity and performance.
• Ensure employee compliance with training, supporting employee engagement efforts, and the ongoing professional
development of individual employees.
• Set the standard for providing timely and consistent feedback to promote positive behaviors and address areas of
growth
• Ensure that clinical services are delivered in accordance with recognized best practices with the continued
development across modalities provided at EmblemHealth.
• Provide operational oversight and support of all programs.
• Continually assess, monitor, and improve policies, procedures, and systems as needed.
• Ensure ongoing understanding of all policies, procedures, and regulatory changes and positively represents
EmblemHealth to external stakeholders.
• Take initiative on individualized projects set by leadership.
• Perform under time constraints in a fast-paced environment with a high sense of urgency.
• Develop and organize the creation and implementation of new curriculum to ensure process measures and outcomes
are improving month over month.
• Participate in external committees and conferences as required.
• Participate in agency committees as appropriate.