Backed with a significant capital commitment from Francisco Partners, a leading global private equity firm, Landmark Health is a high growth, entrepreneurial organization committed to improving healthcare for the highest acuity patients. Capitalizing on the inefficiencies, high costs, and low quality of care delivered to this population, Landmark works with health plans around the country to manage their sickest members on a fully at-risk basis. The company is built upon the core belief that a physician-led, patient-centric, and contextually relevant intervention plan is the key to driving meaningful impact at a population level. By integrating technology, a highly innovative care delivery model, and multidisciplinary clinical teams, Landmark delivers population health management capabilities at scale for the frailest, highest-acuity, most clinically complex segment of the population – the 3-5% of members that account for 20-30% of all national healthcare expenses annually.
The Health Services Director, in partnership with the Regional Medical Director, is responsible for the comprehensive medical management function which includes Management of inpatient care (at all Hospitals and Skilled Nursing Facilities) and Management of outpatient care (in Patient’s Homes or places of residence including long term care settings). The Health Services Director is responsible for the Landmark multi-disciplinary team, and works together with the medical director to assure the delivery of excellent service, high quality care and financial performance of the medical practice.
Essential Duties and Responsibilities:
Accountability for the effective processes to:
- Directly supervise the multi-disciplinary team members including nurse care manager, social worker, pharmacist, dietician
- Is jointly accountable with the RMD for the overall quality of care & clinical outcomes for services within the Regional Market
- Is jointly accountable for all resource utilization
- Ensure multi-disciplinary team satisfaction through continuous feedback and implementation of plans for improvement
- Ensure consistency in the knowledge base and development of multi-disciplinary team including but not limited to nurse care managers, social worker, pharmacists, dietitians, and care management assistants, whether employed or contracted.
Assists in development/dissemination of standardized content and facilitates team learning including:
- Education forums (clinical and managerial)
Establish operational & clinical standards:
- Ensures compliance to Landmark policies
- Participates in weekly Multi-disciplinary team case conferences
- Ensures standardization through chart reviews and in-person site visits and ride alongs
- Acts as a mentor and coach to multi-disciplinary team members
Contributes to planning and implementation of company strategy. Seeks alignment with company goals by representing the Region. Participates in strategic plan development and implementation.
Shares responsibility with the health plan clinical leadership ensuring clinical performance and clinical outcomes in the outpatient services units as defined below:
1. Care Management
- Chair an integrated case management team to review authorization trends, individual case reviews and teachings.
- Provide clinical oversight to the Complex Case Management program including but not limited to:
- Develop and implement action plans, including clinical guidelines to ensure clinically appropriate and efficient utilization of services.
- Provide specific guideline development, implementation and continual improvement.
- Chair an integrated case management review team to provide clinical oversight and key learning’s in individual case reviews
- Monitor outpatient utilization trends, communicate them to the medical group providers, and make recommendations to proactively position the organization to most effectively manage such trends.
- Monitor pharmacy utilization in collaboration with Landmark Pharmacist and work with the health plan staff to create and implement an action plan for managing pharmacy cost trends for the medical group.
- Monitor inpatient utilization trends, communicate them to the medical group providers, and make recommendations to proactively position the organization to most effectively manage such trends.
- Provide and/or supervise the education, assistance, guidance, and feedback to specialty care physicians to achieve appropriate, cost effective patient care.
- Participate in hospital Joint Operating Committee’s
- Participate in the development of an electronic health record or other information systems, as directed by the Chief Medical Officer.
2. Quality Management/ Utilization Management
- Responsible for oversight of UM Programs which meet all regulatory requirements.
- Chairperson of STARS / Quality Committee
- Act as a clinical resource to QM staff.
- Responsible for design and implementation of programs to enable the medical group to meet quality indicators and performance standards of the health plan and other interested parties.
- Responsible for oversight of QM Programs which meet all regulatory requirements.
3. Committee Functions and Leadership
- Co-Chairperson for the Case Management/ Utilization Management Committee
- Participates in the design and implementation of the Utilization Program and any sub-committee’s to enable medical group to meet quality indicators and performance standards of the health plan and other interested parties.
- Participates in the design and implementation of the Quality and Program to enable medical group to meet quality indicators and performance standards of health plan and other interested parties.
- Participates in the design and implementation of the Pay for Performance program
- Approves and monitors the use of clinical guidelines and standing operating procedures for Inpatient or Outpatient Services
4. Health Plan Relations
- Participate in the review of all appeals and grievances
- Interact with health plan medical directors and staff on specific cases as needed.
- Attend periodic health plan committees on issues pertaining to the medical group, as directed by the Chief Medical Officer
5. Claims/Revenue Recovery
- Assist claims processing staff in review of inpatient or outpatient medical claims for unbundling of services or other inappropriate billing practices.
- Assist claims and revenue recovery staff by reviewing and authorizing cap deductions
6. Member Services
- Assist the health plan member services staff when necessary in resolving member complaint issues.
- Review member services trend activity and interact with individual providers as necessary.
- Assist in the development of member related policies and procedures
7. Planning and Policy Development
- Participate in the development and implementation of the Regional Business plan
- Participate in the development and implement of the health plan strategic vision, charters and tactical plans
- Participate in medical group policy development and Regional Business planning activities
The areas of responsibility describe the general nature and level of work performed. The duties listed are not intended to serve as an exhaustive list of all duties, skills and responsibilities required of personnel so classified. Supervisory Responsibilities:
Nurse Care Manager, Social Worker, Pharmacist, Dietitian, Care Management Assistant Competency:
1. Clinical Competence
- Focused on the care management and care coordination
- Critical Thinking/ Decision Making for existing or new treatments and/or technology
- Understands managed care principles and is able to integrate those principles into own clinical practice
- Knowledge of evidence-based medicine methodology for critical appraisal
- Knowledge of evaluation, treatment, and appropriate resource utilization for commonly encountered inpatient and outpatient diagnoses
2. Leadership and Managerial Competence
- Culture Management
- Strategic Planning
- Business Planning & Implementation
- Management of teams and staff
- Problem Solving/ Decision Making
- Conflict Management
- Team Building
3. Personal Competence
- Interpersonal communication/ Human Relations
- Values team members and a strong team player
- Embraces core values of Fidelis
- High ethical standards
- Registered Nurse
- Experience with chronically frail and high risk population
- Management experience with CM, UM, or QM experience
- Possess excellent verbal and written communication skills.
- Possess excellent interpersonal skills.
- Possess knowledge of the processes of managed care operations
- Possess knowledge of the processes of managed care contracting including capitation and risk pool management