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Director, Medical Management Operations

| Waltham
A bit about us: 
We’re on a mission to change healthcare — how it’s paid for, delivered, experienced. We want to put people center stage, not process or profit. We are guided by a deep belief that every person on Medicare should be treated like we would treat a member of our own family: with loving care and a profound commitment to their health and well-being. 
That’s why we’re gathering a whole bunch of smart, big-hearted people to create a new kind of healthcare company — one that combines compassion, health insurance, clinical care, and technology seamlessly. 
We want to throw the long ball with people we love for a cause we believe in. Life is short. Join us.
A bit about this role:
We call our nursing team here at Devoted, Clinical Guides to reflect the caring approach they take. As the Director, Medical Management Operations, you have the opportunity to lead our Clinical Guides to be the nurses you, and they, always wanted to be: nurses who inspire, make a difference every single day and are empowered to follow the health care journey of our members. Working with our Director, Clinical Operations and Health Plan Medical Director, you will help to develop and implement Utilization and Care Management programs which provide member support through assessment, care and ongoing needs. As Manager, you are charged with ensuring compliance with with CMS and any applicable state requirements as well as the appropriate prioritization of the work of your team. As an integral part of our Guide Team you will advocate for our members, coordinate care, and help them ensure they receive the resources and support they need to achieve their health goals (recovering from an illness, improving quality of life, overall well-being). Our Clinical Guide Program is committed to integrity and excellence and empowering members to confidently navigate the healthcare system and live healthier lives.
Our ideal Clinical Guides are caring, compassionate, solutions-oriented, team players that exude enthusiasm in providing an outstanding experience for Devoted Health’s members.

Responsibilities will include:

  • Provide leadership and oversight to the day to day operations of the Clinical Team
  • Daily monitoring of data integrity for all cases to ensure accuracy of data reporting directly to CMS, for CMS Audit Universe and Star ratings; and other internal and external reporting
  • Develop, review, revise and monitor policies and procedures to ensure that all the work of the Clinical Team meets all regulatory requirements and standards. Compare and contract existing procedures against new regulatory requirements to effect changes timely and accurately. Ensure all regulatory,operational and documentation standards and reporting needs are met when integrating new utilization and care management programs
  • Foster a culture of collaboration with other teams across the organization and with our network PCPs
  • Engage with members and understand their needs - use technology and data to better understand the member and any unspoken needs
  • Design and lead the administration of holistic assessments to identify co-morbid conditions, ED/hospitalization history, medications, psychosocial factors, and values and preferences
  • Develop care plan in partnership with the member and their caregivers - problems, goals, interventions - continuously evaluating the member’s progress in meeting their goals
  • Apply knowledge to suggest safe exercise routines, dietary plans, meditation or stress reduction techniques
  • Work closely with Local Service Guides to identify community-based organizations able to support the member in meeting their goals
  • Collaborate with members, providers, and caregivers to ensure a positive outcome
  • Explain complicated medical terms in plain language
  • Educate the member on appropriate care and settings based upon their healthcare needs
  • Support members in understanding diagnostic tests and treatments, including costs, risks, and alternatives so they can make an informed decision about their care needs
  • Prepare members for their inpatient and outpatient treatments and coordinate any care needed post-treatment
  • Support and coach members to improve management of their chronic condition, including medication adherence and compliance

Attributes to success:

  • A deep caring to make a change in the health care experience: you love to serve and make a difference
  • You’ve had proven success in building relationships
  • The ability to adjust your tone and approach to different people
  • You can articulate and break down complex information Being present and timely - for your team, for our members
  • The ability to work in a startup environment: which means being transparent in your work, what’s going well, what’s not
  • Being adaptable to change as we look to make things better for your experience as a Clinical Guide and for our members - we will change things as we go and grow!
  • Being able to balance building a relationship with our members and supporting the business

Skills and experience:

  • The ability to understand operations and the story the data tells
  • Desire to support our RN team in growth to fully support our members (telephonically)
  • A minimum of 3 years of leadership experience (required)
  • Health insurance experience; Medicare Advantage preferred
  • The ability to comfortably multi-task: you’ll be listening, talking and typing all at the same time
  • You’re a great team member with a can-do attitude; you’re self-reflective

If you love running towards complex challenges and transforming them into solutions, if you want to make a potentially huge impact on many lives, and if you are looking for a disruptive startup with an inspiring and talented team, Devoted Health may be the place for you! 
Devoted is an equal opportunity employer. We are committed to a safe and supportive work environment in which all employees have the opportunity to participate and contribute to the success of the business. We value diversity and collaboration. Individuals are respected for their skills, experience, and unique perspectives. This commitment is embodied in Devoted’s Code of Conduct, our company values and the way we do business.
As an Equal Opportunity Employer, the Company does not discriminate on the basis of race, color, religion, sex, pregnancy status, marital status, national origin, disability, age, sexual orientation, veteran status, genetic information, gender identity, gender expression, or any other factor prohibited by law. Our management team is dedicated to this policy with respect to recruitment, hiring, placement, promotion, transfer, training, compensation, benefits, employee activities and general treatment during employment.

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Our sunny office is in the beautiful Watch Factory alongside the Charles River in Waltham. It's easily reachable by commuter train, bus, or bike.