VP of Clinical Services

Job Summary:
The VP of Clinical Services is a senior manager on the PACE management team. This position reports directly to the Chief of Clinical Services. The overarching responsibility for this individual is to ensure the delivery of high-quality nursing and home care services to PACE participants. In addition, this role ensures the high-quality functioning of the Health Centers & effective centralized scheduling.

Job Duties/Responsibilities:

• Leads the Clinical Management Teams of Nursing, Home Care, and Health Center/Scheduling
• Works with clinical management staff to establish protocols, formulate new procedures and benchmarks in response to quality or utilization measurements.
• Creates and modifies operational plan and reporting system that accounts for compliance, quality, ppt satisfaction and staff stability. Plan design incorporates developed outcome measurements.
• Ensures the maintenance and enforcement of clinical protocols and standards of care in the Health Center and among all clinical staff members.
• Develops and upholds systems to protect HIPAA standards, safeguarding the privacy and dignity of participants.
• In collaboration with the Contract Manager, establishes criteria and guidelines to ensure and monitor the quality of the vendors that practice both in the PACE center and in the community.
• Collaborates with contract management to monitor vendors and contracted providers of clinical services for PACE participants and the PACE program, particularly those related to nursing, home care, nutrition, health services, and clinical specialists.
• Provides vendor orientation and on-going education to the PACE program, policies and procedures, and ways to improve communication, care planning and IDT and/or insures this occurs for areas of accountability
• Collaborates as needed with vendor management on a plan of correction when applicable. Evaluates applicable contracts for adherence to their pay for performance benchmarks quarterly.
• Visits as needed with outside contracted vendors and their administration to further the PACE initiative, educate on the PACE mission, foster communication and be a good ambassador in the community.
• Secures resolution for grievances and complaints for areas of accountability from patients or family members and for high-risk incidents.
• Ensures compliance with CDC, DOH, CMS, and State regulations, staying up to date on both state and federal guidelines that govern areas of accountability and impact the program.
• Initiates new policies and procedures, tools, protocols, reports and other measures to monitor adherence to regulations.
• National involvement: participates in national PACE initiatives through NPA and becomes a good neighbor to other PACE sites.
• Partners with the Chief of Clinical Services for BOD level presentations as needed highlighting the positive successes of the Clinical Services area.
• Partners with the VP of Support Services to ensure the Clinical Service area vision is operationalized for areas of accountability.
• Accountable for departmental budget and development of operational initiatives as needed to control costs.
• Reports on outcomes of clinical care at quality and utilization meetings. Collates data: designs reports and creates solutions while also communicating results in clinical, quality and utilization meetings.
• Assists with quarterly QI analysis of infection control in partnership with Nursing.
• Conducts clinical chart audits as it relates to CMS Audit prep and for QI committee activities.
• Works with CMO (Chief Medical Officer) and Senior Director of Nursing & Home Care to establish new clinical protocols, form new committees or refine on-going procedures in response to quality measures when needed.
• Partners with Senior Director of Nursing & Home Care to ensure a effective working relationships between clinical and nursing staff in the home and health center setting to advance patient care, formulate patient center care plans to educate patients/caregivers and foster on-going independence.
• Provides utilization management and review of skilled placements and gathers information for the IDT regarding continued necessity of such placements to make informed, best practice decisions around medically necessary care.
• Ensures the smooth coordination of efforts and high quality of care from all team members according to the care plan or team daily notes for areas of accountability.
• Ensure components of the care plan are consistent with CMS recommendations and guidance/regulations for areas of accountability.
• Maintains oversight over departmental functions that effect care planning decisions and quality of care.
• Works with PACE leaders to assist in the training and mentoring of clinical staff.
• Visits families at home when senior-level administrative support is required or when state agencies are involved in the care process.
• Supports supervisory departments in mentoring/teaching staff, formulating work plans to meet budget requirements, provide cost effective and quality care, and follow the organizations strategic initiatives.
• Partners with Compliance to: Educate and mentor new/existing team members on IDT performance, rules of engagement, team dynamics, the purpose of team meetings, care planning components, and quality of care as it relates to care planning composition and content.
• Partners with Compliance to: Design educational and oversight programming to improve compliance with regulatory requirements across the organization.
• Assumes shared accountability with other senior leaders of the organization to manage participant dissatisfaction and potential risks of disenrollment. This includes the operationalization of new initiatives based on dissatisfaction data.
• Works with the clinical management team to provide support to IDT when determining utilization and medical necessity during IDT and morning meetings.
• Creates the bridge between the Chief of Clinical Services and Senior Directors/Managers, dissecting organizational strategy into operational plans and timelines.
• Collaborates with clinical and medical leadership and the data manager to identify gaps impacting medical cost management and demonstrate cost savings in areas overbudget and/or above historical trends.
• Identifies gaps in care and develop innovative programs and outcomes measurement in collaboration with the Health Center Manager, Senior Director of Nursing and Home Care and CMO.
• Collaborates with clinical leadership in designing and implementing a population health management strategy.
• Partners with marketing to build external relationships, presenting the value-add of PACE to build new enrollment.
• Participates, develops, drives, and collaborates in Quality Improvement Projects.
• Provides communication and problem solving to vendors with clinical/nursing/home care issues. Develops and implements systemic improvements.
• Works with IDT and Senior Clinical and Medical leaders to develop and implement protocols to respond to chronic illness and prevent health crisis/hospitalization.
• Is knowledgeable and adheres to all state regulatory home care statutes and PACE regulations regarding PACE.
• In collaboration with Health Center Manager ensures the appropriate, smooth operation and flow of the health centers through establishing and maintaining clearly defined processes and schedules.
• In collaboration with the Health Center manager enforces the policies and procedures for operational directives and protocols for the health centers, ensuring compliance with quality standards as well as state and federal regulations.
• Reviews utilization data on a regular basis to determine practice patterns and identify areas of operational improvement.
• Ensures clear communication with transportation, health center, specialists, external offices and vendors to assure quality of care and effective scheduling coordination.
• Hosts and facilitates a weekly standup meeting to clearly communicate and address areas of concern pertaining to compliance or quality issues.
• Creates and implements departmental audit system to identify areas of non-compliance and opportunities for quality improvement; use data to inform decision making and action steps. Areas for opportunity to be identified and process improvement and staff education to be implemented and completed.
• Collaborates with and supports Canopy Care Solutions initiatives, integrating them where opportunities arise.
• Performs other related duties as required and assigned.

Required Skills & Abilities:
Ability to maintain confidentiality
Ability to prioritize tasks and meet project deadlines
Proficiency with MS Office Suite or similar software
Dependable and punctual with ability to maintain consistent attendance
Ability to read, write and comprehend English
Ability to maintain sound judgement under stress and communicate effectively
Ability to research and analyze data, draw conclusions, and resolve issues
Ability to read, interpret, and apply policies, procedures, laws, and regulations
Ability to proficiently perform clinical/skilled tasks associated within scope of position

Education Requirements:
Bachelor's Degree, Required
Master's Degree, Preferred

Physical Requirements:
Must be able to tolerate prolonged periods sitting at a desk and working on a computer.
Must be able to lift up to 10 pounds and at times up to 20 pounds.
Must be able to navigate various departments of the organization's physical premises as well as related community care settings.
Must be able to tolerate conditions typically associated within a medical office and/or home care setting including potential exposure to bloodborne pathogens and infectious diseases.

Experience:
10 years of relevant Clinical Services Management Experience, Required
5 years of Staff Management Experience, Required
10 years of experience within a health care organization, Preferred
1 year of experience working with a frail or elderly population, Preferred

License & Certification Requirements:
None

Position Requirements:
Driver's License & access to reliable transportation: community-based travel required.