APC Manager Eastern or Central MA

Position Summary:

Commonwealth Care Alliance's (CCA) Community Intensive Care (CIC) programing is responsible for providing care delivery and care management to a specific panel of high risk and complex people. This panel of patients incorporates the care of individuals with significant medical, behavioral, and social complexities that require intensive care management and care delivery.

Within the CIC Program, the Manager, Clinical APC is responsible for the oversight of clinical care delivery and complex care management within the CIC interdisciplinary team. The Manager, Clinical APC is specifically accountable for assigned Advanced Practice Clinicians and their performance by ensuring specific APC key performance metrics and daily clinical expectations are met. These expectations include oversight of the CIC Program clinical operations for care delivery and care management, patient experience, and interdisciplinary team collaboration.

This role models and develops efficient, highly productive, and effective clinical teams. The role requires skills in data evaluation, implementation of strategic approaches, and application of current healthcare concepts. It leverages strong interpersonal skills across the organization and with external partners.

Supervision Exercised:

• Yes

Essential Duties & Responsibilities:

Management Responsibilities

• Manages and mentors APCs on their team with a dotted line for mentorship to interprofessional team. This can include 1:1 meetings with staff, review of productivity standards, and ensure quality of care standards are met
• Provides specific clinical guidance and coaching for complex situations that require coordination with other clinical and non-clinical staff to ensure patient needs are met
• Models best practices regarding interprofessional teamwork; demonstrates time management skills, workflow efficiency, service decision-making and delivery of high quality patient-centered care
• Responds to reports of clinical concerns by developing mitigation strategies
• Uses decision-making skills to realign resources within the team/site to account for absences or potential staff shortages
• Participates in Quality Improvement and Innovation projects
• Works cross-functionally within the organization to overcome barriers to effective and efficient local workflows
• Assists management and leadership with the development, implementation, refinement and enhancement of clinical programs, initiatives, processes, policies, and workflows
• Conducts chart reviews, technical, logistical and clinical support
• Holds team accountable to meet Key Performance Indicators and proactively identifies areas of opportunity and improvement for individual contributors.
• Creates action/development plans for individual contributors and follows through on plans.
• Accountable for quality and financial outcomes, service utilization, targeted case mix and productivity levels of APCs
• Participates in the selection, hiring, and onboarding of staff as well as performance appraisal, documentation of constructive feedback performance recognition, and disciplinary action
• Participates in committees and workgroups that promote clinical excellence and help to advance CCAs mission and business objectives
• Adheres to CCA's Policies and Procedures
• Promptly, and in good faith, reports an instances of suspected fraud, waste and abuse; suspected privacy and/or security incidents; or any compliance concerns identified
• Ensures confidentiality of patient and company proprietary information is maintained.

Clinical Responsibilities

• Clinical Managers will have a 20-30% clinical APC expectation.
• Ensures that a defined panel of complex individuals receives the highest quality of care, leveraging member centric and individualized approaches within the CIC Model of care
• Provides direct patient care through urgent visits, ongoing chronic disease management, and health promotion and preventative approaches
• Utilizes face to face, in-home, community based, virtual, telephonic, group and case conferencing visit types to enhance patient care and care delivery
• Engages in regular assessments, visits at regularly scheduled intervals, conducts acute visits as needed, ensures patients Plans of Care is comprehensive and addresses significant medical, behavioral, and social needs
• Provides short-term "float" capacity to cover absences within the team and to afford flexible responses to needs of the team
• Maintains close contact and collaboration with the patient's network of providers (PCP and specialists) in the development and implementation of clinical plans of care
• Performs a discrete set of care management/care coordination functions

Working Conditions:

• Standard office conditions.
• Valid Driver's License required - up to 20% travel expectation

Required Education (must have):

• Master's Degree in Nursing, or a degree in Physician Assistant Studies

Desired Education (nice to have):

• Master's in Public Health
• Master's in Education
• Doctor of Nursing Practice

Required Licensing (must have):

• Board Certified Advanced Practice Clinician Licensure (APRN, PA) with licensure in good standing in the state served
• Role requires Medicaid Enrollment
• If works in MA role requires MassHealth Enrollment
• Candidate will be required to pass CCA's credentialing process. This includes, but is not limited to:
• Current Controlled Substances License required
• Current DEA Controlled Substances License required
• Current CPR or Basic Life Support (BLS) Certification Required

Required Experience:

Clinical:

• 3+ years' experience as NP or PA in primary care or care management setting
• 2+ years caring for patients/members with complex medical, behavioral health, and social needs; preferred experience in community setting

Leadership:

• 2+ years team management/ leadership experience
• Experience with conflict resolution

Desired Experience:

Clinical:

• Tertiary care experience
• Interdisciplinary Team experience
• Experience with data-driven evaluation methodologies
• Program evaluation/ analysis

Leadership:

• Team Development
• Project Management

Required Knowledge, Skills & Abilities:

• Other Knowledge, Skills & Abilities:
• Strong interpersonal and communication skills
• Leadership and organizational skills
• Proven success in managing cross functional teams
• Time management and problem-solving skills
• Electronic medical record fluency
• Ability to work in a fast-paced environment
• Proven ability to manage competing priorities
• Familiarity with MA nursing regulatory scope and guidelines

Desired Knowledge, Skills & Abilities:

• Experience with Medicare and/or Medicaid programming
• Quality improvement methodologies
• Process improvement
• Data Analytics
• Customer Relationship Management software (CRM) experience
• Telehealth
• Credentialing and Enrollment
• Coding
• Virtual Care

Language(s):

• Fluent and articulate in written and spoken English
• Bilingual or multilingual

Other Required:

Physical requirements:

• 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
• While performing the duties of this job, the employee is regularly required to stand; use hands to finger, handle, or feel; reach with hands and arms; and talk or hear
• The employee is occasionally required to walk; sit; and stoop, kneel, crouch, or crawl
• The employee must frequently lift and/or move up to 10 pounds and occasionally lift and/or move more than 100 pounds
• Specific vision abilities required by this job include close vision, distance vision, and ability to adjust focus
• Must be able to come to the local CCA office
• May require meetings across the state

Other Desired:

• Program development experience
• Value-based contracting familiarity
• Education/Training experience
• NCQA Accreditation Experience
• Healthcare Quality Measures