<p>Hours: 40 hours; Monday through Friday</p> <p>Location: Primarily remote - candidate must be local for onsite travel as needed to our various Massachusetts locations including Lowell General Hospital, Melrose Wakefield Hospital, Tufts Medical Center, and our Burlington Corporate Headquarters.</p> <p>Job Overview</p> <p>This position focuses on the Medicare Shared Savings Program (MSSP) and Medicare Advantage programs, plays a crucial role in overseeing clinical operations, and driving performance improvements within the Tufts Medicine Integrated Network (TMIN). This position requires a blend of strategic planning, clinical performance improvement skills, a deep understanding of Medicare programs, the ability to analyze data and create performance improvement plans, the ability to communicate effectively with all members of the care team and performance improvement team, including but not limited to: physicians, advance practice clinicians, nurses, community health workers, social workers, medical assistants, practice managers, and TMIN staff.</p> <p>Job Description</p> <p>Minimum Qualifications:</p> <ol> <li> <p>Bachelor's degree in healthcare, nursing, or a related field.</p> </li><li> <p>Five (5) years in managed care or physician group operations with at least two (2) years of experience in Medicare or Government plans.</p> </li></ol> <p>Preferred Qualifications:</p> <ol> <li>Master's degree in healthcare, nursing, or a related field. </li></ol> <p>Duties and Responsibilities: The duties and responsibilities listed below are intended to describe the general nature of work and are not intended to be an all-inclusive list. Other duties and responsibilities may be assigned.</p> <ol> <li> <p>Leads initiatives related to the efficient operation of Medicare Accountable Care Organizations (ACOs) and Medicare Advantage Plans, including performance improvement, clinical alignment, health equity planning, and physician engagement.</p> </li><li> <p>Collaborates closely with the Post-Acute Network and local home care agencies to drive performance throughout the care continuum.</p> </li><li> <p>Leads and ensures performance improvement in contractual quality measures including MSSP electronic Clinical Quality Measures (eCQMs) or Medicare Clinical Quality Measures (CQMs) and quality measures related to Medicare Advantage populations.</p> </li><li> <p>Drives clinical outcomes and efficiency working with PCP practices, care management and Practice Optimization Managers, including but not limited to facilitating regular performance meetings focusing on change, action and accountability.</p> </li><li> <p>Develops and implements innovative programs to support our Medicare patients in collaboration with internal teams to ensure seamless execution and performance.</p> </li><li> <p>Monitors and analyzes product performance, identifying opportunities for improvement and ensuring contractual performance meets or exceeds performance benchmarks.</p> </li><li> <p>Conducts market research and competitor analysis to identify emerging trends and opportunities for product and operations innovation.</p> </li><li> <p>Works directly with the health plan to ensure that all contractual objectives and clinical utilization benchmarks are being met.</p> </li><li> <p>Oversees performance and adherence to Key Performance Indicators (KPIs), collaborating with shared services areas to develop and lead action plans to address performance issues.</p> </li><li> <p>Serves as a liaison for Medicare-related issues, identifying root causes and implementing resolutions.</p> </li><li> <p>Develops and implements corrective action plans for identified issues of non-compliance related to Medicare programs.</p> </li><li> <p>Standardizes and leads weekly performance meetings in conjunction with local Medical Directors.</p> </li><li> <p>Works closely with Care Management leadership to manage daily clinical operations and oversee clinical staff performance.</p> </li><li> <p>Performs efficiency analyses to ensure cost-effective staffing levels for quality patient care.</p> </li><li> <p>Develops and implements patient care policies, procedures, protocols, and goals in conjunction with leadership.</p> </li><li> <p>Participates in the development of the annual operating budget and monitor clinical expenses to meet budgeting goals.</p> </li></ol> <p>Physical Requirements:</p> <ol> <li> <p>Occasionally lift and/or move up to 25 lbs.</p> </li><li> <p>This is largely a sedentary role, which involves sitting most of the time, but may involve movements such as walking, standing, reaching, ascending/descending stairs and operating office equipment.</p> </li><li> <p>Frequently required to speak, hear, communicate and exchange information.</p> </li><li> <p>Ability to see and read computer displays, read fine print, and/or normal type size print and distinguish letters, numbers and symbols</p> </li></ol> <p>Skills & Abilities:</p> <ol> <li> <p>Strong leadership, analytical, and communication skills.</p> </li><li> <p>Proficient in data analysis and performance tracking.</p> </li><li> <p>Knowledge of CMS regulations and value-based payment models.</p> </li></ol> <p>Job Profile Summary</p> <p>This role focuses on developing and implementing programs to establish, maintain, and improve patient quality care standards. In addition, this role focuses on performing the following Performance Improvement/Quality duties: Identifies and executes performance improvement and quality opportunities across the enterprise, enabling successful transformations and driving cost savings, process and product quality, and achievement of business goals. Responsibilities also include partnering with business leaders to provide expert insight on existing processes and procedures, applies process improvement methodologies to achieve PI/Quality objectives, and builds process improvement capabilities. A management role that supervises employees focusing on tactical, operational activities within a specified area, with the majority of time spent overseeing area of responsibility, planning, prioritizing and/or directing the responsibilities of employees. Goal achievement is typically accomplished through performance of direct and/or indirect reports. A role that supervises all levels of employees. Responsibilities that typically include: Setting goals and objectives for team members for achievement of operational results, problems faced may be difficult but typically are not complex, and ensures policies, practices and procedures are understood and followed by direct reports, customers and stakeholders.</p> <p>Tufts Medicine is a leading integrated health system bringing together the best of academic and community healthcare to deliver exceptional, connected and accessible care experiences to consumers across Massachusetts. Comprised of Tufts Medical Center, Lowell General Hospital, MelroseWakefield Hospital, Lawrence Memorial Hospital of Medford, Care at Home - an expansive home care network, and large integrated physician network. We are an equal opportunity employer and value diversity and inclusion at Tufts Medicine. Tufts Medicine does not discriminate on the basis of race, color, religion, sex, sexual orientation, age, disability, genetic information, veteran status, national origin, gender identity and/or expression, marital status or any other characteristic protected by federal, state or local law. We will ensure that individuals with disabilities are provided reasonable accommodation to participate in the job application or interview process, to perform essential job functions, and to receive other benefits and privileges of employment. Please contact us to request accommodation by emailing us at careers@tuftsmedicine.org.</p>