Market Director of Clinical Services - Tennessee - LiveWell Choice, LLC

General Purpose: The individual holding this position is required to support and demonstrate their commitment to the Longevity Health Statement of Purpose, which is: To improve the health and quality of life of nursing home residents by caring for their unique medical, social and emotional needs.

The Market Director of Clinical Services is responsible for achieving the clinical, Medical Loss Ratio and quality goals as described in the Longevity Health Quality and the Annual Clinical Performance Plans, Market Based targets. The Market Director of Clinical Services is the local market ISNP expert, provides education, support and coaching of the clinical team and works in partnership with the local Medical Director and Market Present/Vice President. The Market Director of Clinical Services serves as the Risk Manager for the Health Plans.

Key Tasks and Responsibilities:

• Daily oversight and monitoring of the Model of Care elements/metrics, clinical performance metrics and quality metrics to ensure clinical program quality excellent and contract compliance.
• Primary authority and responsibility for managing the overall clinical operations and quality functions within the market. Facilitating HEDIS and STARs/MTM compliance, communication and ensuring gaps closure.
• Reviewing and disseminating the coding gaps, suspects and low prevalence reports and ensuring NPs are absorbing and closing as appropriate.
• Makes periodic facility rounds to ascertain relationship status, NP integration, PCP receptivity.
• Oversight authority for any delegated entities delivering LHP clinical services, clinical affordability program.
• Responsible for the overall clinical performance of the market‐ HEDIS/STARS rating, Admits/1000, Documentation and Coding accuracy, MTM reviews rate.
• Responsible for conducting nursing home readiness evaluations and making recommendations to the Market President/Vice President and Chief Clinical Officer for implementation in partnership with Network Manager.
• Supervises market clinical resources assigned based on market size and complexity such as the Clinical Implementation Manager, Clinical Field Operations Manager, RN Implementation Support Coordinator.
• Ensures clinical and quality programs are delivered in accordance with state and federal regulations, accreditation standards and health plan objectives. Create and ensure delivery of standards and policies within budgetary guidelines.
• Responsible for the delivery and review of the Annual Quality Improvement Plan, Utilization Management Plan, and affiliated policies, procedures, and staff/vendor training. Actively participates in Quality Improvement Committee Meeting and CCIP program. Drives market based and national quality improvement initiatives.
• Actively participates in Health Plan Clinical Ops, Quality, Delegated Oversight and other assigned Committees/meetings.
• Creates efficient and effective clinical workforce and local supporting clinical and operational processes.
• Responsible with the Account Manager/Market Leader to run the monthly facility meetings with Nursing Home leadership to ensure good working relationships with stakeholders to provide ongoing clinical reviews of hospitalizations and facility metrics and provide follow up interventions.
• Responsible for the oversight of the Clinical manager(s) and all NPs in the market will review performance metrics and NP scorecard and deliver CAP (in consult with COO).
• Conducts market‐based Hospitalization Review Meetings collaboratively with market Medical Director, ensures follow‐up actions in place, accuracy of the hospital tracking data.
• Actively participates in Utilization Management Meetings and reviews, Quality Investigations.
• Leads market clinical performance improvement programs/projects to improve clinical outcomes and develops risk mitigation plans when performance is not on track.
• Ensures effective nursing facility relationships that foster member growth and effective Medical Loss Ratio management.
• Engages market Medical Director in education and enhancement of clinician performance and PCP engagement.
• Accountable for market NP and NP Clinical Manager assimilation and retention.
• Leads innovation and special projects aimed at improving member outcomes.
• Develops and implements cost effective clinical staffing plans and training/support programs to ensure optimal market clinical performance.
• Identifies risks to effective clinical execution and implements plans to mitigate.
• Actively participates in marketing, budgeting, and forecast process.
• Actively participates in medical cost management initiatives.
• Effectively collaborates with Market Leader, Medical Director to engage partners, PCPs, and key stakeholders in achieving market targets.
• Creates an environment of efficiency, effectiveness and avoidance of unnecessary procedures, testing, that may be harmful or that does not improve quality of life for members.
• Where state mandated, ensures NPs have collaborative practice agreements in place and effective oversight monitoring is in place and being done.
• Performs other related duties as assigned.

Licensure:

• Licensed as an advanced practice nurse in home state, ANCC or AANP Board certified.
• Valid state driver's license with a good driving record and proof of automobile insurance required.
• Auto liability insurance declaration page with minimum limits of $100,000/$300,000 for bodily injury and $100,000 for property damage with combined single limit of $300,000. You will be responsible for providing this proof of coverage on an annual basis.

Education and Training:

• Master’s Degree in Nursing.
• Adult, geriatric, family, acute care, primary care OR hospice and palliative, medical psychiatric nurse practitioner education from an accredited school.

Knowledge and Experience:

• Clinical background working in nursing homes or supervising staff in nursing homes, Clinical Quality Program design, Utilization Management Plan implementation, working in a managed care plan/risk bearing entity.
• Leading and managing clinical affordability initiatives.
• Successful experience in managing a team of professionals (NPs, RNs, etc.) to achieve overall program/health plan goals.
• Ability to stay on top of trends in the health care industry with particular focus on competitive analysis, growth, innovation and clinical technology.
• Knowledge of applicable State and Federal regulations, Medicare Advantage Institutional Special Needs Plans Model of Care, STARS‐Quality Program requirements and other regulations, NCQA requirements
• Nursing home background and experience required.
• Computer proficiency, including Microsoft Office Suite.
• Ability to learn and successfully utilize electronic medical records and other clinical software.
• Ability to compile and analyze data to be used for management, differentiation, and marketing purposes.
• Excellent verbal and written communication skills.
• Strong interpersonal skills a must for effectively enhancing relationships with the communities we serve, including the internal organization.
• Excellent public presentation skills.
• Highly organized and able to manage multiple projects, people and deadlines at one time.
• Able to work independently with minimal supervision getting results in a fast‐paced environment.
• Ability and willingness to follow Health Plan policies and procedures, work as a team member, supporting Health Plan programs and services, and represent Longevity Health Plan in a positive professional manner.
• Must have strong knowledge of the healthcare community in the assigned market area.

Company Overview:

Founded in 2018, Longevity Health started as an Institutional Special Needs Plan (ISNP), a type of Medicare Advantage health plan that addresses significant unmet needs of long-term institutionalized members who reside in nursing homes.  Through rapid growth from 2018 to 2022, we expanded our market footprint and currently offer ISNP Medicare Advantage plans in Colorado, Florida, Illinois, Michigan, New Jersey, New York, and North Carolina. 

In 2023, we expanded our service offerings to the broader health plan market.  In addition to our existing markets where we are both the ISNP and the care management team, we are now partnering with National Carriers on their offered ISNP plans in Ohio, Pennsylvania, upstate New York, Georgia, South Carolina, and Texas, with implementations in progress for several other additional US states. This allows us to utilize our core skills of supporting clinical post-acute needs of this vulnerable senior population Currently 13 markets and expanding rapidly.

Company Disclaimers:

Longevity Health is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, gender, national origin, disability status, protected veteran status or any other characteristic protected by law.

It is the policy of Longevity Health to follow Federal and / or State regulations surrounding COVID vaccinations.  While CMS guidelines have been relaxed, there are some LHP facilities which will still require staff be vaccinated in an effort to protect the health of the members / patients we serve.  If your assigned location(s) require all staff to be fully vaccinated, you are required to obtain and / or provide documentation related to your COVID vaccination.  To confirm whether your assigned location(s) require COVID vaccinations, please refer to the Facility Guide Job Aid located on Longevity Health Plan’s intranet site. 

The Company will engage in an interactive process with individuals who cannot be vaccinated for medical or sincerely held religious beliefs to determine if a reasonable accommodation can be made. While an exemption/accommodation may be initially granted, if at any time during employment, it is determined that an exemption/accommodation that has been granted is no longer considered a reasonable accommodation, it can result in employment with the Company ending.

Candidates must meet the Company’s hiring criteria which include a pre-employment background and drug screening.

Longevity Health offers a competitive compensation and benefits package which includes medical, dental, vision, short and long-term disability, life insurance, and 401(k).

Submission of false information during the application process may result in immediate termination of employment without notice.