Director, High Risk Clinical Programs

Job Description:POSITION SUMMARY Under the leadership of the Vice President of Medical Affairs, the Director, High Risk Clinical Programs is responsible for planning, development, implementation, and management of high risk disease management (MERIT) programs within the chronic care SNP. Monitors and implements evidenced based disease management interventions to assure cost effective and quality outcomes for membership served within the health plan, and optimizing ROI within all MERIT programs. GENERAL RESPONSIBILITIES * Transform evidenced based medical guidelines into practical, executable, measurable, and financially viable plans of intervention, including relevant reporting capabilities supported by the IT platform. * Work with the team and/or outside clinical consultants to define clinical objectives, develop program content and participant and physician materials. * Document plans of intervention in a concise manner which focuses on those interventions to drive clinical and business outcomes thus improving ROI. * Develop reporting requirements, data output, and/or other end user documents to support programs. * Manage projects efficiently and in an organized manner, resulting in the timely and cost effective delivery of product outcomes. * Ensures staff receives appropriate orientation, training, and ongoing professional development to meet the needs of the population served. * Establishes performance and productivity standards for all employees of department and ensures that standards are met. Continuously strives to improve departmental and operational efficiencies and workflows. * Coaches, counsels, and implements appropriate disciplinary action within guidelines established by Human Resources. * Assists the Vice President in preparing the Medical Affairs budget. Monitors and implements appropriate intervention to achieve operational budget targets. * Promotes congruence and alignment between disease management programs, utilization management programs, and case management programs. * Coordinate with marketing on the development of materials to promote and support current and/or new programs. * Incorporate the expertise of finance and data analysts to ensure solutions are developed with an appropriate ROI in a collaborative manner. * Collaborate with team and IT resources to define business and functional requirements, workflow processes, system changes and training needs. * Coordinate with analysts, physician advisors, finance, etc. to define program metrics, and evaluate program performance. * Interface and coordinate with varying team members (i.e., physicians, data modelers, claims analysts, business development) to interpret programs into processes and infrastructure. REQUIRED EDUCATION AND EXPERIENCE * RN License required. * Masters degree or equivalent combination of education and experience * Management level experience in a disease management company or a disease management program in a health plan * Minimum of 7-10 years of both clinical health-care related experience and business/leadership experience. REQUIRED KNOWLEDGE, SKILLS, AND ABILITIES * Experience in diabetes, OPD, ESRD and heart failure clinical management is strongly preferred. * Strong project management skills. * Exceptional communication skills required. * Ability to work collaboratively many different audiences is critical. * Proficiency with Microsoft Office applications required. We are proud to be an EEO/AA employer M/F/D/V. We maintain a drug-free workplace and perform pre-employment substance abuse testing. Company: XL Health Location: Baltimore, MD 21201 Job Status/Type: Full Time, Employee Job Category: Administrative/Clerical Industry: Healthcare Services Occupations: Executive Support Career Level: Executive (SVP, VP, Department Head, etc)e Company: XL Health Fax: 410.625.2261 Reference Code: 10466