Manager, Care Management

It’s Time For A Change…Your Future Evolves HereEvolent Health has a bold mission to change the health of the nation by changing the way health care is delivered. Our pursuit of this mission is the driving force that brings us to work each day. We believe in embracing new ideas, challenging ourselves and failing forward. We respect and celebrate individual talents and team wins. We have fun while working hard and Evolenteers often make a difference in everything from scrubs to jeans.Are we growing? Absolutely – about 40% in year-over-year revenue growth in 2018. Are we recognized? Definitely. We have been named one of “Becker’s 150 Great Places to Work in Healthcare” in 2016, 2017, 2018 and 2019, and one of the “50 Great Places to Work” in 2017 by Washingtonian. We recognize employees that live our values, give back to our communities each year, and are champions for bringing our whole selves to work each day. If you’re looking for a place where your work can be personally and professionally rewarding, don’t just join a company with a mission. Join a mission with a company behind it.What You’ll Be Doing:The Manager, Clinical Operations will serve as the liaison to the clinical operations and management with matrix responsibilities to the Plan's Compliance Director, Manager of Delegation Oversight, the Director of Quality Improvement and Director of Health Plan Operations. This position will successfully service, monitor and grow relationships with both internal and external business partners to implement ongoing clinical operations monitoring, resolve barriers, influence decision making and enable achievement of improved clinical quality outcomes and processesWhat You’ll Be Doing: Serve as a liaison between external business partners, internal team members and partner organization providing clinical leadership of SNP including utilization management (UM), care management (CM), quality improvement (QI), appeals and other requirements outlined in the Model of Care (MOC)Provide guidance on clinical operationsPartner with internal and external business partners to drive towards resolution of clinical operations-related issues with an emphasis on root cause analysis and resolution of problemsDevelop deep comprehension of clinical system/platform capabilities, processes and procedures; identify and document limitations of business partners systems, tools and resources and provide recommendations to meet plan requirementsConfirm that all benefit components, clinical protocols and administrative rules have been set up within the clinical payment system; monitor to ensure system and processes are aligned with the requirements as specified in the plan materials (i.e. MOC, evidence of coverage, summary of benefits, PBB)Regularly monitor and analyze clinical operations performance reports and data to inform decision-making, process design or improvement and program modification or implementation; take timely corrective action and follow-up to ensure positive outcomesCompile, review and analyze necessary clinical operations dashboards for management review; create and report operational tracking metrics and dashboards for monitoring clinical operations and performanceIdentify and advise UM, CM, QI, Medicare Operations and other operational leadership of trends, problems, and issues as well as recommended course of action; ensure timely communication; participate in the development and implementation of solutionsMonitor adherence to the efficiency and service level goals including volume, processing, timeliness, accuracy and other metrics, internally and externallyCompose, submit and track clinical system questions and configuration requests to correct identified systemic clinical operations issuesPrioritize issues identified by business partners, internal team members and/or partner representatives and monitors progress in the resolution of the issuesCoordinate the configuration, set up and/or modification of the clinical system/platform following business partner protocolsConfirm that desk level procedures, processes, and policies for clinical operations have been finalized and are aligned with the plan requirementsCoordinate corrective action plans with partner/client and business partner operations/administrator to resolve issues Support internal plan team members with the resolution of daily issuesSupport the clinical and quality team efforts by developing solutions to improve effectiveness and identify continuous improvement opportunities and initiativesWork with other departments to identify and resolve problems leading to incorrect MOC requirements, UM, CM, QI and/or appeals-related processesProvides management assistance for activities specific to the DSNP case/care management program.Assist management in the identification and coordination of the necessary clinical operations and service training needs; monitor and implement educational and process interventions based on data, trends and identified opportunities.Serve on various committees and attends required meetingsPerform other duties and projects as assignedThe Experience You Need:BS or equivalent work experienceNursing License.Three (3) to Five (5) years of experience within a health plan, managed care organization, third-party administrator, or other healthcare entity.Two (2) years of experience in a clinical, quality or closely-related settingPrior supervisory experienceProven success with both individual and collaborative problem-solving, showing demonstrable evidence of sound judgment and decision-making.Ability to work collaboratively across partner/organizationsExperience with Medicare Advantage plansExceptional organizational skillsExceptional communication skillsModels leadership and takes initiativeMaster’s Degree in healthcare, healthcare related discipline or business-related discipline or equivalent work experience Five (5) to Seven (7) years of experience within a health plan, managed care organization, third-party administrator, or other healthcare entity.Three (3) to Five (5) years of experience in a clinical, quality or closely-related settingPrior management experienceExperience in clinical information system report design/developmentProject management experience or equivalent experience leading cross-functional teams to successful completion of projects Entrepreneurial mindset geared toward the creation, execution and continuous improvement of clinical health plan operations and implementationsExcellent written and oral presentation skillsDemonstrated exceptional listening and communications skillsTechnical requirements:Currently, Evolent employees work remotely temporarily due to COVID-19. As such, we require that all employees have the following technical capability at their home: High speed internet over 10 MBPS and, specifically for all call center employees, the ability to plug in directly to the home internet router. These at-home technical requirements are subject to change with any scheduled re-opening of our office locations.Evolent Health is committed to the safety and wellbeing of all its employees, partners and patients and complies with all applicable local, state, and federal law regarding COVID health and vaccination requirements. Evolent expects all employees to also comply. We currently require all employees who may voluntarily return to our Evolent offices to be vaccinated and invite all employees regardless of vaccination status to remain working from home. Certain jobs require face-to-face interaction with our providers and patients in client facilities or homes. Employees working in such roles will be required to meet our vaccine requirements without exception or exemption.Evolent Health is an equal opportunity employer and considers all qualified applicants equally without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, veteran status, or disability status.Compensation Range: The typical range of employees within the compensation grade of this position is $80,000 - $100,000. Salaries are determined by the skill set required for the position and commensurate with experience and may vary above and below the stated amounts.