Director, CM Internal Audit at Cityblock Health
Covid 19 Update - Please Read:
Cityblock requires those hired into this position to provide proof that they have received the COVID-19 vaccine. Any individuals subject to this requirement may submit for consideration a request to be exempted from the requirement (based on a valid religious or medical reason) on forms to be provided by Cityblock. Such requests will be subject to review and approval by the Company, and exemptions will be granted only if the Company can provide a reasonable accommodation in relation to the requested exemption. Note that approvals for reasonable accommodations are reviewed and approved on a case-by-case basis and availability of a reasonable accommodation is not guaranteed. This vaccination requirement is based, in part, on recently established government requirements. The requirement is also based on the safety and effectiveness of the vaccine in protecting against COVID-19, and our shared responsibility for the health and safety of members, colleagues, and community.
Cityblock Health is the first tech-driven provider for communities with complex needs—bringing better care to where it’s needed most, block by block. Founded in 2017 on the premise that “health is local” and based in Brooklyn, we are backed by Alphabet’s Sidewalk Labs along with some of the top healthcare investors in the country.
Our mission is to improve the health of underserved communities. Importantly, our solutions are designed specifically for Medicaid and lower-income Medicare beneficiaries, and we meet our members where they are, bringing care into the home and neighborhoods through our community-based care teams and Virtual Care offerings.
In close collaboration with community-based organizations, local providers, and leading health plans, we are reorganizing the health system to focus on what matters to our members. Equipped with world-class, custom care delivery technology, we deliver personalized primary care, behavioral health, and social services to deliver a radically better experience of care for every member and community we serve.
Over the next year, we’ll grow quickly to bring better care to many more members and their communities. To do this, we need people who, like us, believe that everyone should have good care for what matters to them, in their community.
Our work is grounded in a belief in the power of a diverse community. To close gaps in care and advance equity in the communities we serve, we have to start with making our own team diverse and inclusive. Our ways of working are characterized by creativity, collaboration, and mutual learning that comes from bringing together a community from diverse backgrounds and perspectives. We strive to ensure that every person on the Cityblock team, and every Cityblock member, feels supported and included as a part of our community.
- Aim for Understanding
- Be All In
- Bring Your Whole Self
- Lean Into Discomfort
- Put Members First
About the Role:
As the Director, CM Auditing, you will be accountable for directing and leading the CM Internal auditing team, developing the processes and strategy around key CMS, NCQA, Medicare and Medicaid regulatory and accreditation requirements to ensure Cityblock is meeting contractual requirements and performance targets. You will direct and lead the Cityblock’s care management auditing team overseeing success of the delegation arrangements, contracts and compliance with each of our health plan partners and Cityblock market teams. Accountable for the development, implementation and execution of the CM delegation program including hiring and developing the team. You will directly oversee and lead a team of managers, individual contributors and associates, holding teams accountable and working cross functionally with market teams on shared responsibilities.
- Responsible for leading the the care management auditing life-cycle from contracting and pre-delegation assessment to on-going management and reviews/audits by our health plan partners
- Direct and be accountable for development and delivery of key strategies, plans, and improvement initiatives for the CM auditing program to include: data pursuit strategy, barrier analysis, interventions for compliance improvement
- Develop strong partnerships with the health plan teams in each market to ensure alignment on strategy as well as tactical initiatives including data transfer for chart audits, and monthly reporting standards
- Lead and develop Care Management auditing activities for each existing and new contract, ensuring risks between parties are well defined
- Hire, train, manage, and develop operations associates and managers
- Promote a metrics-driven culture, with the development of consistent approaches to setting performance targets, forecasting and ongoing performance improvement
- Lead in multiple audits and related projects, make judgements around objectives and scope, ensure effective and efficient audit execution
- Oversee, analyze data reported, and identify non-compliance with regulatory requirements and issue corrective action plans (CAPs) as required
- Responsible for the implementation and management of corrective action plans (CAPs)/recommendations when deficiencies are identified and document follow-up to completion
- Act as an operational expert and interventionist through communication, education and design of programs and strategies to assist delegated entities to meet regulatory and NCQA accreditation standards
- Oversee, evaluate and validate Care Management required reporting to ensure continued compliance with delegated responsibilities
- Work cross-functionally across our Clinical, Data and Product teams ensuring reliable regulatory performance across each of our partners
- Serve as the primary point of contact for our partner Delegation Oversight Committees and leads, ensuring key requirements are met, corrective action plans are completed, and new requirements are implemented within our care model
- Partner with market operations teams on strategies to improve care management performance when gaps are identified including training and development
Requirements for the Role:
- 5+ years of leadership experience with demonstrated results as the leader of medical management, quality, care management, or related health plan operations functions.
- 2+ year accreditation experience; NCQA, URAC, and/or CMS regulations.
- 3+ years of experience with CMS, Medicare, Medicaid and/or Marketplace
- You have previously led development, implementation, and operations of successful quality management and/or care management operations functions
- You have experience building a robust performance monitoring structure around quality and care management, ideally in a high growth company
- You are outcomes-focused and data driven, with an ability to bring best practices and strategies to bear quickly in overseeing the team to drive timely results
- You have excellent communication skills and a strong editorial mindset towards clean and crisp messaging. You can modulate content and medium thoughtfully for audience scale and seniority
- You are a strong people manager that can appropriately balance effective delivery on goals as well as strong professional development for direct reports and their teams
- You are a self aware leader and team member interested in feedback and growth.
- You are aligned to the Cityblock mission and dedicated to building a diverse, equitable, and inclusive team.
How We Define Success:
- Maintenance of care management delegation auditing, with high score on audits and meeting core performance metrics
- Development of comprehensive playbook for CM Auditing is in place, positioning us to have influence over key levers to drive total cost of care savings with improved outcomes
- Knowledge of audit processes and applicable federal regulatory and accredited standards
- Attention to detail with analytical and problem-solving capabilities
- Excellent verbal and written communication skills and able to maintain positive relations with internal and external partners at all levels
- Maintain confidentiality and comply with Health Insurance Portability and Accountability Act (HIPAA)
- Ability to establish and maintain positive and effective work relationships with coworkers, clients, members, providers and customers.
Nice to Have, But Not Required:
- Experience with Google suite of products
- Bachelor’s degree in Nursing, or Social Work, or Masters in Healthcare Administration preferred; however, an equivalent combination of education and experience that provides proficiency in the areas of responsibility, may be substituted for the stated education and experience requirements
- Strong knowledge of managed care principles and delivery systems, medical management process, accreditation and regulatory standards delegated oversight processes, and workflow systems
- Knowledge of managed care compliance, CMS regulatory and NCQA standards
- Strong ability to quickly build relationships and trust with our clinical and clinical ops teams
- Strong understanding in Medicaid and Medicare requirements across multiple states
- CCM Certification
- Experience working for a value based care delivery organization
- You have solid presentation and facilitation skills
What We’d Like From You:
- A resume and/or LinkedIn profile
- A short cover letter, please!
Cityblock values diversity as a core tenet of the work we do and the populations we serve. We are an equal opportunity employer, indiscriminate of race, religion, ethnicity, national origin, citizenship, gender, gender identity, sexual orientation, age, veteran status, disability, genetic information, or any other protected characteristic.
We do not accept unsolicited resumes from outside recruiters/placement agencies. Cityblock will not pay fees associated with resumes presented through unsolicited means.