Massachusetts Jobs

Reporting to the VP of Clinical Operations, the Clinical Director of SCO/One Care Programs is responsible for the leadership, development, and oversight of the care teams delivering care management and care coordination across all SCO/One care lines of business. The person in this role will be comfortable in a matrixed environment and adopt a hands-on approach in building a start-up health plan, leading and influencing workstreams to establish efficient and effective care models from concept to implementation and optimization. Responsibilities: Provide leadership and direction for SCO/One Care Clinical Operations, overseeing planning, strategy, and execution of the Medical and Behavioral care management programs while collaborating with various internal and external stakeholders Work cross-functionally under clinical leadership to ensure that the clinical models designed are sustainable and able to function within various financial and regulatory requirements, and in support of quality measures Develop and establish staff and program KPIs to assess the effectiveness of care models and manage staff performance. Foster a culture of collaboration, healthy interactions, and continuous improvement Maintain trusted and collaborative relationships with external partners such as PCPs, FQHCs, community-based organizations, hospital systems, skilled nursing facilities, long-term acute care hospitals, department of mental health facilities, and aging senior access points In conjunction with Finance, develop the business case, financial modeling, and justification for proposed projects/programs in support of improving theefficiency and effectiveness of the clinical programs Promote behavioral health integration within the teams by maintaining close collaboration with behavioral health (BH) leadership and fostering interdisciplinary approaches to care management Collaborate with C3s Education and Training Specialist to develop and evolve appropriate training for new and current staff, inclusive of program requirements, technology used to operate clinical programs, integrated behavioral health and social drivers of health (SDOH) services, and consideration for relationships with internal and external stakeholders Manage clinical application requirements and technical (IT) requirements, in addition to collaborating with other workstreams/stakeholders, in support of effective execution of the model of care across all lines of business Present, facilitate, and lead process improvement forums using methods of culture-appropriate team building and energizing, data gathering and analysis, problem-solving, and project management Manage urgent issues, such as complex member concerns and complaints, and escalate to senior leadership, as appropriate Work with HR and other leaders to recruit and retain staff Foster career development and advancement opportunities for managers and staff through delegation activities, support and mentorship Present regular performance updates on SCO/One Care lines of business to the Executive Leadership Team Special projects and other duties as assigned Qualifications: Bachelors or Masters degree in nursing, psychology, social work, or related field Licensed Clinical Social Worker (LCSW or LICSW), or Licensed Mental Health Counselor (LMHC) or Massachusetts RN licensure or equivalent Experience working with Medicaid/Medicare populations A valid driver\'s license and provision of a working vehicle Case Management certification preferred