Regional Director Care Management and Quality
Reporting to: PHSO President
Supervisory Responsibility: Yes
FLSA Status: Exempt, salaried
Department: MercyOne System Office, Population Health Services Organization
Effective Date: 01/2025
Mission Statement: MercyOne serves with fidelity to the Gospel as a compassionate healing ministry of Jesus Christ to transform the health of our communities.
MercyOne Vision Statement:
MercyOne will set the standard for a personalized and radically convenient system of health services.
MercyOne Cultural Beliefs:
Be ONE
I benefit from and strengthen MercyOne.
Personalize Care
Your experience. My responsibility.
Own It!
I own my actions to deliver our key results.
Improve Daily
I make improvements every day for those we serve including each other.
Innovate
I imagine and embrace bold new ideas to revolutionize health.
Job Summary: The Regional Director of Care Management and Quality is responsible for the overall development and implementation of population health care management and quality improvement strategies across the MercyOne PHSO Partnered Provider Network. As a member of the PHSO Leadership Team, the Director provides oversight/leadership to care management program managers and their respective regional teams, including the areas of acute, post-acute, ambulatory care, pharmacy and quality management. He/she will be responsible for clinical and performance outcomes in value/risk-based arrangements focusing on clinical, cost and quality processes and outcomes. The Director will work collaboratively with regional market Executive(s), PHSO governance groups, regional Medical Directors, Medical Group, Acute Case Management Leaders, Community Health and Wellbeing (CHWB), Pharmacy and Emergency Department (ED) Leaders on corporate strategic initiatives to achieve the desired outcomes that support value based/risk contracts.
Essential Position Expectations:
Provides oversight/leadership to regional (multi-state) care management operations and quality management programs that support value based processes and outcomes. Responsible for clinical and quality performance and financial targets/outcomes in value based contracts. Responsible for resource allocation and budgeting of Care Management and Quality staff. Engages with MercyOne PHSO Chief Medical Officer, Medical Directors, PHSO governance groups, Medical Group, Acute Case Management Leaders, CHWB, and ED Leaders on a routine basis for program/strategy design to ensure optimal performance under value/risk-based contracts. Oversees new accreditation initiatives and maintains existing PHSO accreditations related to delegated service arrangements. Leads strategic initiatives across the PHSO Network including the areas, but not limited to, care management and quality improvement. Maintains and develops on-going education and training programs focused on effective population health care management. As necessary, represents MercyOne PHSO in payer, consortium, and employer meetings. Participates as a member of the MercyOne PHSO Leadership team, on related governance structures and supports regional chapter governance meetings Responsible for leading statewide Clinical Integration Council and maintaining clinical best practices for population health and care management to ensure provider engagement for success under value/risk-based care. Works collaboratively across the organization on care model development. Maintains a strong collaborative relationship with market operations leadership including the areas of Acute, Ambulatory, Post-Acute and Ancillary services. Collaborates with PHSO Analytics team to oversee care management data platform to manage population health initiatives and to measure and track outcomes. Interpret advanced population health analytics to inform care management and quality programs. Work collaboratively with CHWB team to identify and manage at risk populations and SDoH initiatives. Prepares business plans, proposals, special projects and presentations as requested. Oversee all quality reporting, including but not limited to supplemental data, HEDIS, manual submissions, and other regulatory reporting.
Knowledge & Skills:
Subject matter expertise in care management, value/risk-based programs, quality and risk adjustment processes. Ability to lead and oversee appropriate program accreditation (e.g., NCQA Case Management and Population Health accreditations) and ensure compliance with CMS regulations Demonstrated understanding and experience with Quality Data, Risk Adjustment, value/risk-based payment models, and PHSO enablement strategies. Proven ability to innovate and learn new concepts quickly and then adapt from those concepts to develop and execute operational plans. Demonstrated inter-personal team building skills including collaboration, compassion, empathy, and ability to achieve objectives through others by building a positive team culture. Experience in managing multi-site, hybrid teams with effective remote management experience. Detail orientated and strong follow-up skills. Strong executive presence with excellent communications skills, both written and verbal. Demonstrated ability to work with an executive team and Providers on strategic and tactical activities. Proven ability to collaborate and work effectively across a large organization, able to handle a variety of issues, handle multiple tasks and simultaneously thrive in an environment with multiple competing priorities Background in strategy, program and project management/process improvement, or business development
Our Commitment to Diversity and Inclusion
Trinity Health is one of the largest not-for-profit, Catholic healthcare systems in the nation. Built on the foundation of our Mission and Core Values, we integrate diversity, equity, and inclusion in all that we do. Our colleagues have different lived experiences, customs, abilities, and talents. Together, we become our best selves. A diverse and inclusive workforce provides the most accessible and equitable care for those we serve. Trinity Health is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, status as a protected veteran, or any other status protected by law.