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Director, Health Plan Development & Implementation

Overview

Leads the implementation of Health Services clinical operations for products/programs offered through the VNSNY Care Management Organization (CMO). Collaborates with leadership across the Enterprise to create and implement efficient clinical processes, ensure appropriate utilization and develop evidence-based care management policies and procedures to support new products/programs and meet regulatory standards. Collaborates with other disciplines to ensure workflows are comprehensive for clinical handoff to provider, claims and enrollment. Works under limited direction.


Responsibilities
  • Participates in the strategic planning to discuss and set milestones and objectives for program performance. Tracks progress against project plan and identifies any deviations with suggested plan to remediate.
  • Defines core clinical processes required for successful implementation of new products and/or programs.
  • Collaborates with IT, BIA, and other support areas to ensure the appropriate infrastructure is in place to effectively deliver operationally excellent services.
  • Collaborates with Quality, Education, and Compliance to ensure clinical services are high-quality, consistent with best practices, and compliant with regulatory requirements.
  • Develops implementation plans and roadmaps for clinical service roll-out.
  • Develops and revises workflows, with emphasis on cost improvement, timeliness and automation.
  • Leverages existing or defines new monitoring tools; works with business staff develop and implement.
  • Monitors performance and productivity of the team and individual members; leads appropriate operational changes and takes action to ensure guidelines and goals of the customer agreement is met.
  • Ensures issues and deficiencies identified during internal or external audits are addressed and corrected.
  • Partners with internal and customer implementation delivery teams and plays advisory role related to partner implementation, delivery and optimization.
  • Identifies external services and partnerships that support clinical program and goals. Works with external and internal stakeholders to select, on board, and monitor these programs.
  • Participates in special projects and performs other related duties as requested.

  • Develops a strategy focused on the education needs for Care Management Organization (CMO) members.
  • Collaborates with education team to create appropriate training for care management staff to support execution of clinical programs.  Assess the health status of potential partner’s membership and target populations from membership that may identify opportunities to impact programs and education. 
  • Oversees projects to ensure projects are moving effectively and in accordance to goals, objectives and established milestones with measured criteria. Provides leadership and direction for change management initiatives and program implementation.

Qualifications

License and current registration to practice as a registered professional nurse or License Clinical Social Worker in New York State preferred. 

Master’s degree in nursing, social work, counseling, public health or a related field required.

Minimum of eight years of progressive health care operations management or program development experience required.  Strong knowledge of health care delivery systems, medical management IT platforms, managed care, and patient care required.  Strong knowledge of federal and state health care regulations related to Medicare, Medicaid, managed care, and long-term care required.  Strong knowledge of geriatrics, community-based care, and long-term care required.  Demonstrated ability to collaborate and interact cooperatively with all levels of management and their staffs required.  Strong systems thinking and process improvement success skills required. Strong analytical skills and excellent oral, written and interpersonal communication skills required.  Proficient PC skills, including MS Excel and Word required. 


ABOUT US

The Visiting Nurse Service of New York (VNSNY) is one of the nation's largest not-for-profit home- and community-based health care organizations, serving the five boroughs of New York City, and Nassau, Suffolk, and Westchester Counties. For over 125 years, VNSNY has been committed to improving the health and well-being of people through high-quality, cost-effective health care in the home and community. We offer a wide range of services, programs, and health plans to meet the diverse needs of our patients, health plan members, and clients from before birth to the end of life. On any given day, VNSNY employees - including nurses, rehabilitation therapists, social workers, home health aides and other professionals - deliver compassionate care, unparalleled medical expertise, and 24/7 solutions and resources to approximately 40,000 individuals in our care helping them to live the best lives possible in their homes and communities.