Vice President, Care Delivery Operations

Why This Role is Important to Us
Commonwealth Care Alliance (CCA) is a not-for-profit care system committed to providing integrated healthcare and related social support services. Created in 2003, CCA offers a full spectrum of medical, behavioral health, and social services for people with complex needs covered under Medicaid and for those "dually eligible" for both Medicaid and Medicare.
CCA is recognized nationally for its innovative Model of Care that improves quality and health outcomes and reduces overall cost of care. Through its dedicated team and its contracted partners, CCA currently serves over 42,000 members in nine locations across Massachusetts and has annual revenues approaching $2.3 billion. In 2022 CCA expanded product offerings to MA, RI, MI, and CA with MAPD health plans and ACO management to include additional 21,000+ lives. Expansion into additional new markets is expected in the near future.
CCA offers the unique and high potential of working with both a payer and clinical delivery system that offers unique and powerful venue to create value and scale innovation.
Reporting to the General Manager, CCA Care Delivery, the Vice President, Care Delivery Operations is responsible for oversight of all operations across our portfolio of direct Care Delivery programs. The $40M business unit, with more than 230 staff, includes four service lines -- Primary Complex Care, Behavioral Health Substance Use Disorder, Older Adults Serious Illness, and Urgent Stabilization Programs. There are multiple distinct programs within each service line, all of which are oriented to serving more than 14K members with complex health and social needs who are part of our Duals or Medicare Advantage plans.
Direct care programs are delivered across multiple sites of care including at our two clinics in MA, we perform the majority of care via home visits, we are expanding our virtual services, we have a hospital bedside service for high utilizing patients, and we see patients in long term care facilities. Our model is flexible so that when needed, we can care for members in the ways that works best for them. For example, we will meet our members on a park bench or at a coffee shop to ensure they get the care they need.
Our team is deeply committed to caring for members with:

• Neurodegenerative disorders
• Severe disability with and without independence
• Chronically un-housed
• Serious and persistent mental illness and substance use disorders
• Multiple chronic conditions
• Primary care for wellness, and prevention

The Care Delivery team's work is focused on:

• Continuous improvement and validation of our proven unCommonCare model
• Optimizing Care Delivery Operations
• Replicating and reshaping programs for new markets
• Pioneering and showcasing Care Delivery innovations

As part of the Care Delivery Leadership Team, the Vice President of Care Delivery Operations will have ultimate responsibility for the provider practices within the business unit including all aspects of daily operations such as patient scheduling, staffing, budgeting and financial controls, revenue cycle management, productivity, KPIs and data analyses, procurement and vendor relationships, inventory management, risk mitigation controls, compliance, support systems such as EMR usability and provider support tools, physical plant, etc.
Supervision Exercised: Yes
What You'll Be Doing
Major areas of responsibility:

1. Manage Practice Operations leaders within each service line, supporting their team and personal development. Their teams include both credentialed (with dotted reporting line to Medical Directors of the Service lines) and non-credentialed providers and administrative staff.
2. Ensure each Care Delivery program is managed to the approved budget, pro formas/decision models, KPIs, and leadership expectations.
3. Drive continuous improvement of established programs and recommend opportunities for reshaping programs to fit within different market/product environments.

Specific Responsibilities:
Operational

• Ensures excellence in design and execution of patient scheduling, productivity, KPIs and data analyses, call handling, procurement and vendor relationships, inventory management, risk mitigation controls, regulatory compliance, support systems such as EMR usability and provider support tools, physical plant, and other duties as assigned.
• Lead each team to develop an operational playbook for their program, outlining with specificity the staffing model, patient workflows, schedules, logistics, financials, etc. so the program can be replicated in other markets.
• Champion special strategic projects to maximize efficiency, such as geo-mapping for home visit scheduling to reduce windshield time.
• Serve as thought leader on how to establish a pricing model to set pricing for clinical services and an intra-company chargeback model.
• Advise on and create workflows for appropriate use of brick and mortar vs. virtual vs. home visits.
• Establishes, implements, and communicates the strategic direction of the team's operations
• Collaborates with executive leadership to develop and meet company goals while supplying expertise and guidance on operations projects and systems
• Collaborates with other divisions and departments to carry out the organization's goals and objectives
• Identifies, recommends, and implements new processes, technologies, and systems to improve and streamline organizational processes and use of resources and materials
• Ensures that departmental decisions and project plans such as those for staffing, development, organization, material efficiency, hardware acquisitions, and facilities are in line with the organizations business plan and vision
• Establishes, communicates, and implements operations-related policies, practices, standards, and security measures to ensure effective and consistent support and execution
• Leads the organization's plan to achieve goals of membership growth, expanded clinic services, hospitals footprint, and greater operational efficiency within existing programs
• Implements strategic organizational initiatives
• Manage relationships with outside organizations/partners in conjunction with clinician support
• Understanding and developing physical plan needs for space required for expanded clinics and member experience centers and other programs
• Maintains knowledge of emerging technologies and trends in operations management
  Identifies training needs and ensures proper training is developed and provided

Financial

• Oversees P L of all Care Delivery programs, managing medical expense ratio (MER), administrative expenses, and meeting budget.
• Develop operating and capital budgets which maximize ROI and programmatic goals.
• Responsible for budgeting process and implementing financial controls for all programs.
• Responsible for revenue cycle management, driving operational efficiency (HCC coding, etc.), and maximizing revenue.
• Presents monthly performance reports and metrics to leadership.
• Leads cost optimization initiatives such as using economies of scale for centralized purchasing.

Staffing

• Guiding, directing, evaluating the work of practice operations management staff
• Responsible for hiring, training, performance reviews of direct reports
• Leading, managing, mentoring, and developing direct reports and their teams, and manage consultants as needed
• Optimizing and articulating roles and responsibilities for all positions, career pathing, and developing talent benches.
• Monitor and update staffing models to support organizational goals.
• Identifying, training, and developing leaders within the company and setting them on the path for management.

Growth

• Propelling primary care brand strategy and marketing needs forward within clinical Care Delivery and external partners
• Participate in business development opportunities as relevant
• Support teams and track Key Performance Indicators (KPI) related to clinical care for members
• Support diversification via telehealth technologies (video, chat, etc.) for a clinically appropriate clinical care and care management services.
• Be committed to observing, reporting, and enhancing patient and employee safety as part of an overall emphasis on continuous improvement, learning, and member experience in the organization.
• Monitoring the competitive landscape and attending industry events to stay abreast of new innovations in Care Delivery

Integration

• Key in engaging and supporting Clinical Initiatives across CCA as a thought leader

Working Conditions

• Standard office conditions and travel to Clinical sites.

What We're Looking For
Education Required:

• Bachelor's degree required

Education Desired:

• Master's degree preferred

Experience Required:

• 10+ years of leadership experience in healthcare industry
• Background in provider/payor sectors
• Proven track record of clinical care team management in a provider setting with at least 20k outpatient visits/yr. and responsibility for budgets of 40M+.

Knowledge, Skills Abilities Required:

• Demonstrated ability to effectively drive strategic transformation work
• Track record of success bridging clinical, financial and administrative priorities and people
• Strong interpersonal skills and ability to build long-term relationships
• Experience designing and delivering presentations to internal and external stakeholders, including Executive Leadership
• Results driven, able to self-direct and work independently as well as perform in a team environment
• Ability to understand and set priorities, handle varying tasks simultaneously, and design work plans to track progress, resolve issues, and efficiently and effectively see tasks to completion
• Demonstrated ability to work effectively in a matrix organization
• Position will require some travel to different sites
• Able to support teams with utilization of telehealth technologies (video, chat, etc.), when appropriate, as an approved modality for a variety of clinical care and care management services.
• Excellent verbal and written communication skills
• Strong supervisory and leadership skills
• Extensive knowledge of the principles, procedures, and best practices in the industry
• Excellent organizational skills and attention to detail
• Strong analytical and problem-solving skills

Language(s) Required:
English