ConcertoHealth Inc. is the leading provider of specialized primary care and supporting clinical services for complex, frail, elderly, and dual-eligible patients. Operating exclusively in value-based agreements, ConcertoHealth provides high-touch, individualized care for patients, and deploys wraparound clinical resources to extend the reach of primary care practices. This comprehensive medical management solution, elevated by Concerto’s proprietary population health technology, improves overall healthcare quality and patient outcomes, benefitting payers and their provider networks. The company is headquartered in Irvine, Ca. For more information, please visit www.concertohealth.com.
The Care Management Quality Monitoring Lead will report directly to the VP, Clinical Operations to develop and oversee standards of excellence in all aspects of care coordination performance and documentation quality as well as directly supporting a constant state of audit readiness for both internal and external partners/agencies.
The Care Management Quality Monitoring Lead, reporting to the VP, Clinical Operations, is responsible for the development and implementation of standards of excellence for the care management team and further evaluates the quality of the care management team performance and documentation. This role requires that the Care Management Quality Monitoring Lead:
Perform at the direction of the VP, Clinical Operations and support the Market Executive Director, to develop and oversee activities such as establishing care management standards of excellence including but not limited to design and implementation of audit tools and performing Inter-Rater Reliability (IRR) assessments.
Acquire and maintain relevant clinical, technical, and information systems knowledge (TruCare, Patient 3D, etc.) and utilize such internal systems knowledge to develop and monitor the quality of care coordination performance and documentation
Design, deliver, evaluate and track quality performance and documentation in accordance with the regulatory standards for which the Company is contractually obligated (e.g. three-way contract between the State, CMS and health plan), accepted standards of care management and care coordination practices, the applicable Model(s) of Care, the delegated arrangement and company policies and procedures, including tracking and trending audit and monitoring results.
Establish a feedback mechanism to the managers of care management and the training function to ensure that remediation and performance management occurs in a timely fashion.
Escalate any concerns including, but not limited to, patient safety, clinical care risks, documentation, or compliance with regulatory requirements, to VP, Clinical Operations and/or the Market Executive Director.
5 years of experience as a practicing health plan care manager or auditor
Bachelor’s degree strongly preferred
Ability to work in a fast paced, dynamic environment and work well with others on a team
Demonstrate ability to perform multiple concurrent tasks with minimal supervision and meet deadlines
Demonstrate a sound understanding of contemporary healthcare with strong focus on clinical practice and clinical information systems/ applications
Proficiency in creating formal training materials and course documentation, including electronic learning development
Strong presentation skills and good verbal and written communication skills
Customer service oriented
Computer literate – proficiency in operating personal laptop, projector, learning management system, and other trainer tools
Proficient in Microsoft Office Suite
Experience training in medical facilities, exposure to medical office procedures is a plus
Proficiency in clinical information systems (i.e. electronic health records)
Excellent planning and organization skills
Possess a professional demeanor and appearance