Lead, Care Management Accreditation
At Cityblock Health, our mission is to radically improve the health of urban communities, block by block. We integrate services to address physical, behavioral, and social needs together, delivered at community hubs and through field-based care teams to make healthcare more accessible, supportive and goal-driven for the people who need it most.
Every aspect of the Cityblock care model is carefully designed to focus on our members, engaging and empowering them to own and improve their health through trusted relationships. Through mobile interdisciplinary care teams, we are flexible in how we deliver care, meeting members where they are, and together developing and working longitudinally through a personalized and integrated Member Action Plan (MAP). The care team collaborates to support each member’s whole health and social needs. Enabled by custom-built technology, we build capacity, deliver care and dramatically change members’ opportunities and outcomes.
Partnering with community-based organizations and a well-respected commercial partner in New York, and backed by the top healthcare investors in the country, we are reorganizing the health system to focus on what matters to our members—and leading the move from transactional, fee-for-service medicine towards high-value, relationship-based partnerships.
As the Care Management Accreditation lead, you’ll spearhead our care management delegation programs, managing the life-cycle from the pre-delegation assessment to on-going management and reviews/audits by our health plan partners. As we grow and scale to new markets and partner with more health plans, you will lead policy development, reporting, and quality improvement strategies that ensure Cityblock remains compliant with state, federal and NCQA regulations. You’ll work cross-functionally across our Clinical, Operations, Data and Product teams to optimize the care management program regulatory performance across each of our partners, including working with care teams and tracking the program through audits and clinical reports. You will be the primary point of contact for our partner Delegation Oversight Committees and leads, ensuring all requirements are met, corrective action plans are completed, new requirements are implemented within our care model.
- Lead Cityblock’s care management delegation program as the business owner for care management delegation arrangements with each of our health plan partners
- Create and maintain accurate, complete written policies and procedures for all regulatorily required care management policies
- Define and implement audit programs that ensure that Cityblock proactively identifies and implements solutions (at the employee, hub/clinic, regional or national level) to audit findings
- Oversee and manage all care management delegation reporting and audit preparations
- Works cross-functionally across the clinical, data, product and operations teams to ensure that needed regulatory technology, operations and data requirements are documented, prioritized, implemented and trained
- Manage the comprehensive Cityblock regulatory care management program description and partner-specific CMS Model of Care documentation
- Participate in the Quality Improvement Committee and actively ensure that the Cityblock quality program meets the needs articulated in the program description and the care management delegation agreements
- Act as the primary point of contact with the Care Management delegation lead for Cityblock partners
- Lead the delegation oversight committee meetings as the Cityblock representative
- Maintain expert knowledge of current and ongoing updates, revisions, modifications or changes in federal or state statutes, regulations and mandates, including but not limited to federal and state insurance and managed care laws, privacy laws, NCQA Standards, CMS Requirements and partner-specific requirements -- and lead implementation of changes within Cityblock as a result of changes to these rules and regulations
- Be responsible for creating and maintaining accurate, complete written policies and procedures with respect to Cityblock and any subcontractor obligations and responsibilities
- Develops key points and training materials and works with Learning & Development to ensure learning objectives are met
- Find opportunities to meld state, national and NCQA requirements with Cityblock’s care and operating model
You’d be a good fit if:
- You have 5+ years experience overseeing care management delegation and compliance in a health plan or health care provider
- You have great attention to detail and an interest in using regulations to strengthen processes within innovative care models
- You’re skilled at using data and performance improvement tools to drive care management program improvement
- You have an understanding of care management delegation regulations across states and at the federal level, including NCQA and CMS requirements
- You have clinical operations experience
- You work well with clinicians and other stakeholders across healthcare settings to roll-out projects
- You have good project management abilities
- You can effectively collaborate with senior leaders at a health plan partner to articulate Cityblock’s care management policies, processes and compliance
Nice to have:
- You are an RN, SW or have another clinical license
- You have worked both at a health plan and within a clinical delivery system
- You have experience working collaboratively with an interdisciplinary care team, and specifically working alongside community health workers or care coordination staff.
You should include these in your application:
- A resume and/or LinkedIn profile.
- A 1-2 paragraph response indicating why this job is compelling to you.
Cityblock values diversity as a core tenet of the work we do and 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.