Director of CM Delegation Oversight

| Greater NYC Area | Remote
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#communityhealth #healthcare

About Us:

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.

Our Values:

  • Aim for Understanding
  • Be All In
  • Bring Your Whole Self
  • Lean Into Discomfort
  • Put Members First

About the Role: 

As the Director, CM Delegation Oversight, you will be accountable for directing and leading the CM Delegation team, developing the processes and strategy around key CMS, NCQA, Medicare and Medicaid measures to ensure Cityblock is meeting contractual requirements and performance targets. You will direct and lead the Cityblock’s care management delegation team overseeing success of the delegation arrangements, contracts and compliance with each of our health plan partners and Cityblock market teams. 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. 

  • Direct and be accountable for development and delivery of key strategies, plans, and improvement initiatives for the CM delegation program to include: data pursuit strategy, barrier analysis, interventions for rate improvement and monitoring & evaluation and compliance
  • Responsible for partnership with the health plan teams in each market to ensure alignment on strategy as well as tactical initiatives including data transfer for quality measures, chart audits, and monthly reporting standards
  • Lead and develop Care Management Delegation activities for each existing and new contract, ensuring responsibilities between parties are well defined
  • Draft and oversee SLAs for each contract, maintaining appropriate databases of policies, procedures and processes for oversight
  • Partner and participate in multiple audits and related projects with the Director or Auditing, 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
  • Partner with the Director of Auditing to aggregate and analyze audit findings into a reportable format and report to appropriate departments to identify corrective action plans and health plan responses
  • 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
  • Set the direction of the care management life-cycle from contracting and  pre-delegation assessment to on-going management and reviews/audits by our health plan partners
  • 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
  • Hire, train, manage, and develop operations associates and leaders 
  • Promote a metrics-driven culture, with the development of consistent approaches to setting performance targets, forecasting and ongoing performance improvement

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:

  • Direct and build care management delegation team, with high score on audits and meeting core performance metrics
  • Development of comprehensive playbook for CM Delegation 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.

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We do not accept unsolicited resumes from outside recruiters/placement agencies. Cityblock will not pay fees associated with resumes presented through unsolicited means.

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.
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Technology we use

  • Engineering
  • Product
    • PythonLanguages
    • ScalaLanguages
    • SqlLanguages
    • ReactLibraries
    • Node.jsFrameworks
    • PostgreSQLDatabases
    • Google AnalyticsAnalytics
    • LookerAnalytics
    • ConfluenceManagement
    • JIRAManagement

Location

Cityblock is committed to flexible work. Due to the COVID-19 pandemic, most of our business team is operating remotely.

An Insider's view of Cityblock Health

What's something quirky about your company?

There's a slack channel for everything - plants, podcasts, cooking, baking, hiking, Peloton - I love it

Tina

Implementation Manager

How does the company support your career growth?

My manager and I do monthly check-ins on career development during our 1:1s. This has been a great opportunity to address areas I'd like to improve and set up an action plan.

Jose

Senior Software Engineer

What are Cityblock Health Perks + Benefits

Cityblock Health Benefits Overview

To properly care for our members and advance equity in the communities we serve, we believe our own team must be diverse and inclusive. We take to heart what it means to bring your whole self and actively work to build representation, build belonging and advance justice. Our goal is to ensure everyone at Cityblock feels respected, celebrated, and part of our community.

Culture
Volunteer in local community
Partners with Nonprofits
Friends outside of work
Eat lunch together
Intracompany committees
Daily sync
Open door policy
Team owned deliverables
Team based strategic planning
Group brainstorming sessions
Open office floor plan
Diversity
Documented equal pay policy
Dedicated Diversity/Inclusion Staff
Highly diverse management team
Unconscious bias training
Diversity manifesto
Diversity Employee Resource Groups
Hiring Practices that Promote Diversity
Health Insurance & Wellness Benefits
Flexible Spending Account (FSA)
Disability Insurance
Dental Benefits
Vision Benefits
Health Insurance Benefits
Life Insurance
Wellness Programs
Mental Health Benefits
Retirement & Stock Options Benefits
401(K)
Company Equity
Child Care & Parental Leave Benefits
Generous Parental Leave
Flexible Work Schedule
Remote Work Program
Family Medical Leave
Vacation & Time Off Benefits
Generous PTO
Paid Holidays
Paid Sick Days
Perks & Discounts
Casual Dress
Commuter Benefits
Relocation Assistance
Home Office Stipend for Remote Employees
Professional Development Benefits
Lunch and learns
Cross functional training encouraged
Promote from within
Customized development tracks
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