- Functions as a member of the Physician Enterprise Innovative Care team providing direction and leadership throughout the St. Vincent Physician Enterprise related to the development, implementation and workflows related to utilization, population management and care management initiatives that increase patient engagement, improve staff productivity and optimize financial and clinical efficiency.
- Responsible for the development, implementation and monitoring of utilization and care management activities.
- Represent St. Vincent Physician Enterprise with external entities on matters related to utilization, population management and care management activities as directed.
- Support physicians and interdisciplinary team in facilitating patient care to enhance the quality of clinical outcomes and patient satisfaction while managing the cost of care and providing timely and accurate information to payors.
1. Serves as the lead in the development of the SVMG Care Management project design. Demonstrates understanding of emerging healthcare delivery models. Program design model will include but not limited to:
Management of Care for Patients with High Health Care Needs.
Access to Care 24/7 utilizing patient data tools to provide real-time, personal healthcare information to patients.
Delivery of appropriate and timely preventive care.
Engagement of patients and caregivers to actively participate in their care.
Coordination of care across medical specialties through a medical team approach.
Develop standardized processes to implement the SVMG Care Management program.
Develop, implement, monitor and modify utilization and care management operations, consistent with benefit design, product design, reimbursement methodology and network design.
Design processes and programs to appropriately reduce medical costs and increase quality of care to patients.
Lead and support network, quality programs, medical policy process and credentialing as needed.
Chair committees related to both processes internal to Care Management but also those that monitor and integrate cross functional processes across the Enterprise.
Perform routine duties associated with utilization, risk, case and care management, grievances and appeals as assigned.
Respond to measures of clinical managed care performance using quality management statistics and interventions.
Interface with physicians, facilities and other providers as necessary
Support workgroups, committees and task forces as assigned.
Ensure compliance with regulatory requirements.
Translates program objectives into operational goals in collaboration with Administration.
4. Collaborates with administration in support of the program design assuring that it:
Incorporates the mission and philosophy of Catholic Health Initiatives and St. Vincent in daily activities.
Directs program design toward improving System strategic position.
Analyze and Access Program Performance
Identify and track targeted program outcomes, utilization and performance data monthly
Monitor trends and report patient outcomes to Care Management team evaluate clinical and financial effectiveness
Review and report outcome and quality information to Administration
Improving and sustaining Performance
Assess overall performance to identify areas for improvement
Identify resources needed to drive improvement within the program
Collaborate with physicians and personnel to achieve quality patient care, access, costs and satisfaction
Communicate outcome measurements and quality indicator results throughout the participating clinics
Maintain knowledge in clinical practice, medical record documentation and quality indicators to make appropriate clinically-based judgment in data extraction process
Serve as a resource to physicians and staff in understanding program criteria of quality, access, cost and satisfaction across the medical neighborhood
Conducts chart reviews and identifies improvement opportunities
Other duties as assigned.
Current RN licensed in the State of Arkansas. BSN preferred.
At least five years health care experience in an Ambulatory setting. A background in utilization review or medical auditing preferred. Healthcare management experience preferred.
Speaking, hearing, seeing, and walking, ability to lift and carry 11-24 pounds, exposure to inside environmental work conditions.
Excellent written, verbal and interpersonal communication skills; public speaking skills; excellent organizational and team building skills. Ability to understand and analyze processes and projects to lead the organization in the development of a Comprehensive Primary Care model. Proficient in the use of personal computers, electronic health systems; able to type proficiently. Must be organized, able to set priorities and capable of working effectively with minimal supervision. Must work well as a team member.
Senior management, physicians and staff.
Vice President of Physician Enterprise
Incumbent has access to confidential patient and/or non-patient related information and must comply with the terms of SVHS/CHI Policies as they apply to their job role.
St. Joseph Medical Center - 15 months ago