Clinical Integration & ACO Compliance Contact

Position Summary

The Clinical Integration and ACO-Compliance Contact position is a key strategic and operational leader for OneHealth Nebraska. The person in this role provides leadership in assessing, developing and implementing quality metrics to deliver superior clinical, financial and operational outcomes. The ACO-Compliance Contact will promote a culture of ethics, patient safety and compliance. This role is responsible for all ACO-compliance policies, education and training along with monitoring rules and regulations required by State and Federal law. This role is for a 29 member independent Accountable Care Organization (ACO) in Lincoln, Nebraska. Flexible scheduling and annual bonuses.

Responsibilities

The individual must be able to perform the following satisfactorily;

• Provide leadership, strategic oversight, and guidance to ensure ACO quality and budget goals are met.
• Provide oversight to all aspects of contract administration of value-based population health payer contracts.
• Coordinates and manages clinical network to ensure clinical excellence, high levels of patient satisfaction and safety, reduce costs and demonstrate clinical quality achievement.
• Provide leadership and guidance on programs and services that ensure improved patient-centered care including preventative services, wellness initiatives, population health management and other applicable programs.
• Support value-based care initiatives by leveraging data to guide decision-making, track quality measures and report on clinical performance.
• Identify opportunities for care improvements and cost savings by analyzing ACO contract data.
• Collaborate with ACO clinic participants to implement process changes.
• Assist ACO leadership and finance in the development of financial models to forecast ACO contract performance.
• Manages day-to-day operation of the ACO Compliance Program including responding to client questions and/or concerns.
• Ensures ACO policies and procedures are accurate, current and in compliance with Federal and State regulations.
• Reports to the ACO-Board, ACO CEO, ACO CMO and ACO-Participants on all compliance issues.
• Promote a culture of ethics and compliance throughout the entire organization.
• Other duties as assigned.
  
  

Qualifications And Education Requirements

• Minimum 3-5 years of experience in healthcare operations and regulatory compliance.
• Associates or Bachelor's degree expected. RN, LPN, or Care Coordinator preferred. Experience may be considered.
• Experience working with healthcare claims data, EHRs, and other healthcare data systems preferred.
• Healthcare background and work experience required.
• Excellent oral and written communication skills.
• Experience and knowledge of Microsoft Office Suite.
  
  

Preferred Skills

• Prior experience within or a part of an Accountable Care Organization (ACO) preferred.
• Strong working knowledge of healthcare regulations, including Medicare, Medicaid, other Commercial payers and ACO and value-based organizations.
• Ability to educate and guide members in successfully implementing quality initiates and compliance.
• Excellent interpersonal skills with member clinics, RN's, LPN's, Care Coordinators and Physicians.
• Detail-oriented with a focus on data accuracy and quality.
• Ability to work in a fast-paced environment with rapidly changing priorities.
• Ability to resolve issues and address conflict.
  
  

Additional Notes

• Self-directed independent performer, able to act independently and manage day to day objectives.
• Self-motivation and initiative in learning new programs, policies and skills
  
  

Benefits

• Pay: $75,000 - $85,000 per year plus annual bonus
• Flexible Schedule
• Work location: In person
  
  

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