Facility: 531 Roselane Street NW

Job Summary:

The Executive Director, Ambulatory Care Management provides executive leadership and strategic guidance for the Population Health Ambulatory Care Management team. This position will be responsible for ensuring that members of the Ambulatory Care Management team utilize evidence-based guidelines and case management standards of care to deliver timely and effective patient-centered care across the continuum. The Executive Director Ambulatory Care Management will develop and implement workflows that are patient centered, in accordance with principles of value-based care and aligned with overall system strategy. The Executive Director Ambulatory Care Management will report to the Assistant Vice President for Population Health Management and will have direct reports including the Director for Ambulatory Care Management and the Director for Employee Plan Care Management. In close collaboration with their direct reports, this position will have oversight of teams responsible for providing care management services to patients attributed to various payers, including Medicare fee for service, Medicare Advantage, Medicaid, Commercial payers and the Wellstar Health Plan. Establishes overall care management goals and objectives and implements plans and activities designed to facilitate the patient's transitions across the care continuum, to manage their medications and chronic health conditions, to assist in reducing unnecessary care and readmissions, to increase preventive care and achieve highest quality outcomes. Participates in the system's Integrated Care Management Leadership Council and serves as Chair of the Clinical Practice sub-Council. Collaborates with leaders in primary care and specialty service lines; inpatient care management; post-acute care; and home-health, to improve communication and develop workflows designed to facilitate and improve the patient's experience across the health care continuum. Continually evaluates all outpatient and inpatient handoff and communication workflows to ensure that patients are consistently receiving delivery of the best supportive resources in a coordinated fashion at the right time in the right setting. Utilizes Data and Analytics to develop strategic priorities for the ambulatory care management program. Works with Population Health Data and Analytic leadership to develop meaningful case management reports that are generated routinely and utilized to assess the allocation of case management resources for specific populations (health plan, product lines) and rebalance as needed. Uses the reports to prioritize case management focus and prioritization of programs. Collaborates with Wellstar Clinical Partners (WCP) physicians and leaders to establish, track, and report medical utilization benchmarks and develop and test innovative programs/initiatives as needed for performance improvement. Explores innovative programs such as chronic care management for feasibility and potential benefit. Provides leadership and expertise in securing regulatory and health plan compliance with case management standards of practice. Collaborates with the leadership teams across the organization to facilitate the achievement of common business goals and share case management subject matter expertise and program successes. Job Responsibilities/Duties Manages the overall budget for ambulatory care management Oversees CM position control and hiring of new staff Directs and optimizes the development and implementation of evidence-based, best practice CM processes and interventions Ensures that staff have the resources necessary for onboarding and for acquiring and maintaining their evidence-based care management knowledge Leads directors to develop evidence-based training curriculum Establishes and evaluates CM productivity metrics; reviews CM ratios routinely and directs caseload rebalancing as needed Contributes to the clinical, quality, financial, and member/beneficiary and provider satisfaction outcomes. Acts as a resource to other departments across the organization regarding case management Develops workflows and standards to identify and outreach to high-risk populations, including rising risk, chronic disease, complex care, frailty and multiple chronic conditions. Provides oversight of case management compliance with all external and internal CM requirements and ensures the quality of CM provided to members/beneficiaries Collaborates with the compliance team to ensure regulatory requirement are followed all times. Responsible for meeting and exceeding Compliance Requirements, conducting Root Cause Analysis, and Corrective Action Plans. Works with leaders and direct reports to plan, prioritize and implement strategies to improve and sustain employee engagement efforts and encourage continuous process improvements.

Core Responsibilities and Essential Functions:

Evaluate, develop and ensure implementation of evidence-based standards of care for ambulatory case management. Ensure that workflows are aligned with the goals and objectives of the value-based contracts. Establish and monitor outcome-based goals and objectives. Engage with department stakeholders to improve workflows that improve the patient's journey through the care continuum and optimize the patient and provider experience. Work closely with AVP Population Health Management to develop strategy, goals, activities and metrics to drive optima l performance across all contracts. Monitor and evaluate OP Case Management staffing, positions, productivity and effectiveness * Focus on performance to decrease number of inappropriate ER/IP visit, facilitate appropriate medication management, increase disease specific health coaching, behavioral modification, and improve transitions of care. * Utilizes data and analytics to drive improvement. Engages team in continuous performance improvement * Ensure proper onboarding and education/orientation, data tracking and analysis, documentation and compliance with program initiatives. * Proficient in communicating clearly and effectively with multiple constituents Develop and monitor programs as new populations, tools, technology, and workflows are identified * As new contracts are initiated, partner with Wellstar Clinical Partner operations, managed care, and payors to design, implement, and monitor new programs. * Develop business case and operating model for new ambulatory care management programs * As new technology is identified, integrate new technology and data into workflows. * Partner with external community organizations and/or internal departments to develop partnerships and build capabilities outside of population health as necessary. * Communicate with data program performance and outcomes across ambulatory care management Departmental Specific Duties * Review the Department program to ensure compliance to state and regulatory guidelines. * Utilizes knowledge of insurance regulations and compliance guidelines. * Monitors financial performance against budget and acts quickly to correct when variance occur. * Develop budgets and executive summaries to communicate outcomes and priorities. Performs other duties as assigned Complies with all Wellstar Health System policies, standards of work, and code of conduct.

Required Minimum Education:

Registered Nurse with a minimum of 10 years of experience in case management Required and Master's Degree in healthcare related field Required

Required Minimum License(s) and Certification(s):

All certifications are required upon hire unless otherwise stated.

• RN - Reg Nurse (Single State) or RN-COMPACT - RN - Multi-state Compact

Additional License(s) and Certification(s):

Required Minimum Experience:

Minimum 10 years in healthcare, including 5 years in case management Required and Minimum 7 years of progressive leadership experience Required and Minimum 2 years in program development Required and Minimum 5 years or greater experience as a staff nurse in an acute care setting Required and Minimum 5 years Expertise in creating presentations, executive summaries. Competency in developing evidence-based protocols and guiding performance improvement initiatives. Required Minimum 2 years Experience in EPIC, Healthy Planet, or Compass Rose Preferred Minimum 2 years Experience in developing and/or managing Chronic Care Management programs Preferred

Required Minimum Skills:

Proficiency with Microsoft office suite and working with excel spreadsheets. Excellent written and verbal communication skills. Strong problem-solving skills and ability to multitask. Proficient in preparing and, maintaining records and written reports. Ability to establish and maintain effective working relationships with physicians and office staff, hospital staff, community partners and vendors. Ability to interpret, adapts, and applies guidelines and procedures. Ability to analyze complex clinical scenarios and apply critical thinking. Extensive knowledge of managing patient populations, transitions in care and community resources.