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Fresenius Medical Care North America Program Director, Population Health Management in Austin, Texas

Job ID 21000EDV

Available Openings 1

Position Specific Information

This Position is 100% Remote

PURPOSE AND SCOPE:

The Director, Care Navigation supports FMCNA's mission, vision, core values and customer service philosophy and adheres to the FMCNA Compliance Program, including following all regulatory and FMS policy requirements. The incumbent is responsible for developing, implementing and overseeing a care management program that is consistent with the philosophy of Fresenius Health Plans (FHP). The Director, Care Navigation is responsible for ensuring that FHP's Care Management programs are compliant with Centers for Medicare and Medicaid Services (CMS), National Committee for Quality Assurance (NCQA), URAC or general accreditation standards as well as State and federal regulatory requirements. The incumbent oversees and advises FHP senior leadership on all care management lines of business including Chronic Kidney Disease (CKD) programs, telephonic Case Management (CM) and CKD care coordination services as well as ESRD Care Navigation Unit (CNU) care coordination programs. The Director, Care Navigation ensures that Care Management services meet any and all FHP contractual lines of business and comply with state mandated service provider licensing requirements. The incumbent will serve as a resource to the clinical staff, administrative staff, and external regulatory agencies in all issues relating to Care Navigation and Management.

PRINCIPAL DUTIES AND RESPONSIBILITIES:

  • Design, develop and implement related care management programs and processes in line with the organizational strategy to include:

  • Outcomes that align with each product line that improve overall effectiveness of the program

  • Effective and efficient strategies that compliment and reinforce CNU real time care coordination platform

  • CKD programs that are inclusive of comprehensive patient education specific to the population in each stage of CKD (1, 2, 3a, 3b, 4, 5).

  • Identify alternative delivery models for CKD patient education when opportunities dictate

  • Continually evaluate and improve the workflow of all Care Management business segments to ensure ongoing alignment with coinciding IT delivery platform

  • Develop areas of opportunity for CM or CNU to assist in identified patient HRA care gaps for each appropriate line of business.

  • Serve as the primary liaison between FHP, FMS field operations as well as non-ESRD field personnel pertaining to all matters and strategic implementation regarding care management services.

  • Work closely with the Health Services Chief Medical Officer to determine future in-depth and complex clinical strategies that will jointly improve patient care while reducing overall delivery costs.

  • Lead high-level Provider discussions focused on Care Management initiatives and programs that will benefit patient outcomes and identify opportunities for CNU (or the broader care management team) to create value through strategic interventions.

  • Work closely with internal FHP stakeholders and leadership, including Utilization Management and Operations, to ensure smooth delivery of FHP deliverables.

  • Develop education targeting each Care Management segment. Additionally, act as an internal resource for the Sales and Marketing team to provide ongoing education for their teams where applicable.

  • Provide strategic leadership of short- and long-term goals through the use of thoughtful techniques in the communication of the company’s mission and core values as a means to implement positive change and/or create organizational structure within the Care Management team.

  • Ensure that budgets and schedules are within FHP requirements with significant organizational responsibility for the overall control of planning, staffing, budgeting, expense priority management, and recommendation and implementation changes of current methods.

  • Work closely with the Integrated Care Analytics department, develop KPIs to track and measure KPIs for performance and productivity for the CNU, CM, CKD and any future Care Management delivery segments.

  • Provide leadership, guidance and coaching for all direct reports to maintain an engaged and productive workforce; partnering with Human Resources on employee matters.

  • Ensure that adequate systems exist to monitor and track all pertinent licensed staff to meet any federal and state ongoing requirements of coverage focused on no lapse in licensing.

  • Collaborate with employees in the establishment of clear and concise development plans to ensure succession planning and the advancement of future leaders within the organization.

  • A strong tactical decision-maker; role primarily focuses on tactical execution. Handle unforeseen issues.

  • Work on complex issues where analysis of situations or data requires an in-depth knowledge of organizational objectives.

  • Require the ability to change the thinking of, or gain acceptance from, others in sensitive situations, without damage to the relationship. Regularly interact with senior management or executive levels on matters concerning several functional areas, divisions, and/or customers.

  • Interact frequently with internal departments and external customers/vendors; particularly in problem resolution.

  • Responsible for hiring, coaching and counseling employees, including performance reviews, disciplinary action and terminations.

  • Provide technical guidance.

  • Assist with various projects as assigned.

Additional responsibilities may include focus on one or more departments or locations. See applicable addendum for department or location specific functions.

PHYSICAL DEMANDS AND WORKING CONDITIONS:

The physical demands and work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Travel may be required.

SUPERVISION:

May be responsible for the direct supervision of various levels of related care navigation staff.

EDUCATION:

Bachelor’s Degree; Advanced Degree preferred

EXPERIENCE AND REQUIRED SKILLS:

  • 6+ years’ related experience.

  • 3+ years’ experience as a Manager; or 3+ years’ experience in a senior managerial role.

  • Demonstrated experience managing one or more departments.

  • Technically proficient leader in related department and knowledge of industry practice and business principles. Large range within CNU, CM and CKD management, preferred.

  • Strong computer skills with demonstrated proficiency in word processing, spreadsheet, database, presentation and email applications.

  • Strong management skills with the ability to lead cohesive and productive teams.

  • Strong interpersonal skills with the ability to communicate with all levels of management through diplomacy and tact.

  • Excellent oral and written communication skills.

EO/AA Employer: Minorities/Females/Veterans/Disability/Sexual Orientation/Gender Identity

Fresenius Medical Care North America maintains a drug-free workplace in accordance with applicable federal and state laws.

Addendum:

Specific Roles & Responsibilities

  • Leads project management workstreams related to the ongoing development and performance of renal value-based care programs and complex case management programs

  • Directs program initiatives including, but not limited to engagement strategies, marketing and communications, new client implementations and vendor implementations

  • Works closely with Data Analytic and Actuarial teams to develop and monitor program performance reporting

  • Supports Vice President, Value Based Care Programs in strategic business planning and the development and delivery of stakeholder presentations

  • Oversees and supports career development path for value-based care program manager(s)

  • Serves as a program liaison to the InterWell Health nephrology network and internal Fresenius business partners

  • Plays an integral role in defining business requirements for Salesforce Health Cloud business systems analysts and development teams

Required Experience

  • Previous experience with Health Plans and demonstrated knowledge of Medicare Advantage, Medicaid and Commercial programs – self-funded and fully insured

  • Experience working collaboratively with healthcare providers

  • Experience with value-based payment solutions

  • Demonstrated knowledge of external regulatory and accreditation agency rules and regulations such as NCQA and CMS.

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