Clinical Operations & Client Service Delivery: | Dayton, OH, United States
As a collaborative member of a team of nurses, social workers, physicians, pharmacists, health economists, and program coordinators, you will have the opportunity to make a profound impact on the lives of people living with multiple chronic illnesses.
Population health – collaborative care management leadership
- Provides clinical leadership and development for a population health programs or functional area within Medical Management, e.g, patient centered medical home, health and wellness, population management, high risk care management, reporting capability, etc.
- Assists in assuring appropriate health care delivery for the assigned membership and managing the medical costs associated with the assigned population.
- Helps recruit, develop and motivate population health-care management staff
- Promotion of managed care systems using evidence-based medicine to educate and facilitate best practices with care management staff and medical providers
- Stratification, continuous evaluation and restratification of population for appropriate resource allocation
Physician and provider relationship management
- Responsible leading change with physicians and other providers, especially PCMH practices, to improve the quality and efficiency of care in the network and integrate these providers into our clinical initiatives.
- Visits network facilities on a regular basis, identifies key issues facing leaders and works collaboratively with leadership to accomplish mutually agreed upon goals.
- Creates and maintain a system that gives feedback to providers individually and collectively regarding managed care effectiveness of individual providers and networks.
- Nurtures a culture where delivering the highest quality yields lowest cost
- Participates in the development of physician incentives and gain sharing arrangements.
- Provides critical thinking for analyzes, evaluation and modification ofdata reports (e.g., medical, pharmacy, quality) and assist Evolent stakeholders with the translation of information to knowledge and action to contracted physicians and providers.
- Develop, maintain and grow relationships with key clinical leaders with the assigned market.
Quality of care and service delivery
- Provides guidance and interpretation on issues of medical appropriateness, benefit application as appropriate, level of care necessary to include out-of-network care.
- Maintains up-to-date knowledge of new information and technologies in medicine and their application to Evolent’s clients
- Evaluates and ensures systems and processes to assist providers with adherence to evidence based protocols
- Chairs or staffs peer review committees and
- Participate in the Appeals and Grievance process, as necessary, to assure timely, accurate responses to members
- Assures compliance related to Federal (e.g., CMS), State (e.g., Insurance commission) and local rules and regulations.
- Graduate of an accredited medical school. M. D. Degree is required. MBA, or a Master's Degree is preferred in healthcare, or other related fields of study.
- 3-5 years of clinical practice in a primary care setting and progressively responsible medical administrative experience.
- Proven ability in medical leadership position possessing clinical credibility with peers and the ability to be a team player and team builder.
- A thorough understanding of all aspects of managed care, including HMOs, PHOs, risk arrangements, capitation, peer review, performance profiling, outcome management, care coordination, pharmacy management, and patient centered medical home concepts.
- Excellent interpersonal, verbal, and written communication skills.
- Consistently completes continuing education activities relevant to practice area and needed to maintain licensure.
- Ability to navigate in a corporate matrix environment.
Evolent Health supports progressive health care systems lead, build and own the path to value-based care. Evolent is a high-growth, entrepreneurial company founded in 2011. We are backed by established players in the health care industry: The Advisory Board Company (NASDAQ: ABCO), University of Pittsburgh Medical Center Health Plan, the nation’s second largest provider-owned plan, and TPG Growth, part of an investment firm with $55.3 billion of assets under management. Our investor partners contribute proven population health expertise, intellectual property, and strong financial backing to propel our leadership in the market. Evolent integrates the people, processes and technology needed to advance value-based care delivery and innovative payment models.
Selected as one of Modern Healthcare’s Best Places to Work, Evolent provides an opportunity to work with top experts in the health care field in an organization committed to career development. Our rapid growth is made possible by a team of professionals who thrive in a dynamic, fast-paced environment. While our team comes from a variety of backgrounds, we share a passion to advance health and health care, and a desire to pursue our passion in an innovative setting.
Our accessible leadership team cultivates an open door environment. We don’t like approval chains; we love ideas and people with the courage and conviction to bring novel solutions forward. We win as a team and always ask how we can do better. We respect and encourage commitments outside of work. While we don’t all work the same way or the same hours, we are all dedicated to exceptional results.
Our Work Environment
Headquartered near Washington, DC in Arlington, Virginia, we have additional sites in San Francisco, Pittsburgh and in client markets across the country. Our open workspace is specifically designed for collaboration and efficiency. Walking treadmill desks, an onsite fitness center, healthy snacks and fitness challenges are a part of our expansive wellness program. Evolent also sponsors company-wide community service projects and supports individual volunteering.
Our Compensation and Benefits
We recognize and reward our most valuable asset—our team—with competitive pay and annual performance-based bonuses. Evolent also offers comprehensive health benefits, a company-matched 401(k) beginning day one and flexible spending accounts for daycare and transit. Each employee receives 25 personal days and 10 holiday paid days off each year.
An Equal Opportunity Employer