Clinical Lead, Ambulatory Care Quality and Care Management

ORGANIZATION

Answer Health is a high-performing, integrated physician network serving independent practices and providers across Western and Northern Michigan. We represent approximately 200 independent practices and provide the infrastructure, tools, and support required to adapt to a rapidly changing health care environment.

AH offers a wide range of value-added services designed to enhance the efficiency and effectiveness of independent practices, including:  credentialing, payer contracting, data integration, performance analytics, quality improvement, clinical programs, care management, pharmacy support, risk adjustment, billing/coding support, financial management, incentive rewards, communications/ education, group purchasing, practice support, and growth.

 

AH Mission

“To help patients and independent medical practices thrive.”

AH Vision

“Answer Health is the premier practice choice for independent providers and their patients.”

Value Statement                                                   AH Values

We make service our priority                  =         Committed, Passionate, Responsive

We are forward-thinking                          =         Progressive, Creative, Innovative

We are dependable                                    =         Reliable, Trustworthy, Consistent

We are a team                                            =         Collaborative, Supportive, Respectful

We are proud of our organization         =         Dedicated, Invested, Engaged

 

JOB SUMMARY

The clinical lead monitors ambulatory quality and patient experience performance metrics, enhances clinical care processes, and ensures the highest quality of care delivery across our primary care and specialty practices. This role reports to the Director of Clinical Performance, supports our Medical Directors, and serves as a resource for the AH Clinical Performance team and practice leadership related to clinical programs. The clinical lead coordinates activities of our practice-based care management teams to ensure appropriate training, adherence to clinical standards and protocols, and improved patient engagement. They actively share best practices through practice meetings and work groups, fostering a collaborative and connected team environment. The clinical lead engages with operational and clinical leadership within practices to develop sustainable clinical process changes, driving improved quality, utilization/cost, and patient experience outcomes. They also interface with health plans and regional/national value-based partners.

 

ESSENTIAL FUNCTIONS

The roles and responsibilities of this job support Answer Health's culture, mission, vision, values, and key strategies. To perform this job successfully, an individual must be able to perform each essential function satisfactorily.

Duties and responsibilities:

1. Monitors efficiency and effectiveness of clinical programs and services provided across ambulatory practices.
2. Guides the activities of care managers engaged in planning and prioritizing care for individuals and populations of patients, focusing on strategies that will promote optimal health.
3. Assures care manager compliance with training and credentialing requirements; monitors utilization and referral patterns, clinical case load, and program needs.
4. Maintains professional relationships with providers when cases require referral for specialized treatment or to another level of care.
5. Supports the AH Clinical Performance team on PCMH, quality, and performance improvement activities, including Medicare Advantage.
6. Lead and support practice work groups, meetings, and webinars related to care management, clinical care, and process improvement.
7. Work with partnered primary care and/or specialist practices on infrastructure, quality, utilization/ cost, and patient experience performance.
8. Participate in payer and other meetings supporting process and performance improvement on all clinical initiatives.
9. Support for defining, implementing, and monitoring evidence-based care pathways and clinical standards.

Skills and abilities:

1. Ability to work autonomously, with strong leadership, time management, priority setting, and organizational skills.
2. Excellent written, verbal communication and interpersonal skills.
3. Ability to make independent decisions based on strong problem-solving skills.
4. Ability to listen to others and maintain strictest levels of confidentiality.
5. Ability to function effectively in a fluid, dynamic, and rapidly changing environment.
6. Ability to develop positive, longitudinal relationships with practice managers, clinicians, and work colleagues.
7. Competency in the use of computer hardware and software systems (e.g., Microsoft Office).

Physical Effort:  The job includes limited physical demands, typical of the job that includes regular walking, standing, stooping, bending, sitting, typing, use of phone, and some lifting of light weight objects.

Mental & Visual Fatigue:  Work may produce mental/visual fatigue. Detailed, interactive work which requires alertness and sustained concentration.

Answer Health is committed to providing reasonable accommodation to qualified individuals with disabilities so that they can perform the essential functions of their position.

 

EDUCATION, LICENSURE, AND CERTIFICATION

Required Qualifications:

Clinical Degree from an Accredited College or University in healthcare or a field closely related to clinical improvement/process improvement/project management.

1. A bachelor's degree or equivalent in nursing or a related health care-related field.
2. Experience with quality, process improvement, and care management initiatives in an ambulatory care setting.
3. Previous experience with third-party payer programs, including PCMH, HEDIS, etc.
4. Time management, priority setting, coaching and development, work delegation, and organization.
5. General computer knowledge

Preferred Qualifications:

1. Master’s degree or related work experience.
2. Minimum of five years of experience working on quality, process improvement, and/or care management initiatives with practice managers and clinicians.
3. Experience with electronic medical records, registries, and population health tools.
4. Previous experience with incentive modeling.
5. Previous experience working with an ACO.

Other:

All employees must ensure that services are provided in accordance with state and federal regulations, organizational policy, and accreditation and compliance requirements.

Employees are expected to demonstrate reliable attendance and are expected to demonstrate by attitude and action their recognition of the necessity of positive and professional interaction with co-workers and the critical importance of effective and respectful communication with co-workers, staff of other affiliates, customers, patients, and visitors.

It is expected that all employees will work effectively with teammates, helping others to contribute to the overall success of Answer Health. These core expectations are considered an essential function of all positions at Answer Health.