Job Summary:

The Director for Transitions and Integra@Home Programs, provides management and oversight of the development, implementation, and management of key clinical initiatives and programs directed at enhancing the performance of the Integra Community Care Network ACO and non-ACO patients of the primary care providers. Specifically, the Director oversees two critical components of Integra’s population health services:

• The Transitions of Care program, designed to support Integra PCP patients as they transition out of and into inpatient facilities, emergency departments, and skilled nursing facilities.
• The Integra@Home program, which provides intensive acute and urgent services to highly complex patients in their homes, with the goal of preventing ED and inpatient admissions.

Duties and Responsibilities:

Planning, developing and project managing new and existing clinical operational initiatives and monitoring progress to drive performance, including the management of program budgets

Developing and implementing disease management programs (e.g., CHF, COPD, asthma, diabetes, ESRD)

Managing program risks and issues and taking corrective action as necessary

Managing stakeholder communication

Managing program documentation

Developing program key performance indicators and outcomes

Developing program ROI when applicable

Oversee collaboration across internal and external departments and organizations

Demonstrates leadership by planning and overseeing multiple, inter-related, complex, and operational and population health projects to drive performance improvements in initiatives and programs for Integra’s populations, under the direction of senior administrative and clinical leadership.

Manages and coordinates activities across Integra’s operational teams, steering workgroups and stakeholders to mitigate risks and ensure the business is successful in meeting its goals.

Participates in vendor relations, external partnerships and management activities when necessary.

Presents findings and recommendations for action to Integra senior leadership.

Demonstrates planning expertise in business development, pro forma development, budget development and analysis.

Presents ideas, concepts, programs, data and analyses to various audiences to build consensus on new performance improvement initiatives.

Monitors, interprets and reports on changes in market trends, health care delivery systems and legislative initiatives which impact ACO population health program efforts.

Proactively assists in the discovery and development of ACO population health performance improvement and disease management initiatives.

Maintains relationships with external organizations

Experience leading change and driving program development.

Advanced problem-solving skills.

Strong interpersonal skills and ability to interact positively with a wide range of constituents.

Ability to work both independently and within a team environment and a multi-dimensional environment. Creative, flexible, self-motivated, professional must possess sound judgment and ability to plan and initiate new activities consistent with achieving service excellence.

Analytic skills to collect information from diverse sources and summarize the information and data in order to solve problems.

Ability to function effectively within an ever-changing environment and to meet deadlines and reprioritize as necessary.

Requirements:

BA/BS required; RN degree with MBA, MHA. MSW or graduate nursing degree is preferred.

5 -10 years working in a fast-paced health care environment, and healthcare provider and/or payer experience are required. ACO, Medicare, Medicaid population health experience is strongly preferred.

A minimum of three (3) years of clinical nursing experience is required.

RI RN License preferred.

One of the following certifications is required: Certified Case Manager (CCM), Nurse Case Manager (RN, CM), Case Manager, Certified (CMC) or Certified Professional Health Care Quality (CPHCQ), or CDOE.

Care New England Health System (CNE) and its member institutions Butler Hospital, Women & Infants Hospital, Kent Hospital, VNA of Care New England, Integra, The Providence Center, and Care New England Medical Group, and our Wellness Center are trusted organizations fueling the latest advances in medical research, attracting the nation’s top specialty-trained doctors, and honing renowned services and innovative programs to engage in the important discussions people need to have about their health.

Americans with Disability Act Statement: External and internal applicants, as well as position incumbents who become disabled must be able to perform the essential job-specific functions either unaided or with the assistance of a reasonable accommodation, to be determined by the organization on a case-by-case basis.

EEOC Statement: Care New England is an equal opportunity employer. All applicants will be considered for employment without attention to race, color, religion, sex, sexual orientation, gender identity, national origin, veteran or disability status

Ethics Statement: Employee conducts himself/herself consistent with the ethical standards of the organization including, but not limited to hospital policy, mission, vision, and values.