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Clover Health

Clover Health is a unique health insurance plan focused on driving down costs and producing improved health outcomes.

Medical Director, Complex Care Management
Remote
New Jersey, US
Job Description / Skills Required

Clover is reinventing health insurance by working to keep people healthier.

The Direct Contracting team is responsible for the development and implementation of an exciting new Center for Medicare and Medicaid Innovation (CMMI) value based care initiative. The Direct Contracting payment model is the latest initiative launched by the CMS Innovation Center aiming to improve outcomes and reduce expenditures across the Medicare Fee for Service (FFS) population. Taking from previous similar models (i.e. Next Generation ACO), the key differentiator is the program’s targeted appeal to organizations who traditionally are not involved in managing FFS lives by offering a broad array of opportunities for them to engage in value-based arrangements with aligned providers. Clover is participating as a Standard Direct Contracting Entity (“DCE”) and will launch its DCE in April of 2021.

We are looking to hire a team of Medical Directors to support the growth and expansion of our Complex Care Management (CCM) programs within our Direct Contracting initiative. In this role you will interface directly with CCM preferred providers/vendors including in-home primary care providers, home health agencies, and hospice agencies to improve the care and outcomes of high cost/high needs beneficiaries within our DCE

As a Medical Director you will:

  • Develop and execute engagement strategies designed to build and grow mutually beneficial partnerships with preferred complex care providers including in-home primary care providers, home health agencies, and hospice agencies at local, regional, and national levels. 
  • Work closely with internal clinical operations team, complex care providers and participant providers to maximize referral of targeted/medically appropriate beneficiaries into complex care programs
  • Work closely with complex care providers to ensure adherence to high clinical quality standards, including with respect to enhanced access to care, comprehensive medication management, timely care transitions visits, appropriate advanced care planning/end of life care, and other areas
  • Ensure close coordination among complex care providers including in-home primary care programs, home health agencies, and hospice providers, as well as close coordination between complex care providers and referring participant providers
  • Leverage benefit enhancements associated with DCE to help build novel care transitions and care management programs with CCM providers, in particular in-home care providers and home health agencies
  • Contribute to the development of Clover’s technology platform to support complex care management of Clover DCE and MA beneficiaries 

You will love this job if:

  • You are dedicated to improving the care and outcomes of older adults by providing superior, personalized, patient-centered care.
  • You are excited by big, complicated problems and try to solve them with creative, elegant, and simple solutions. You have a natural intellectual curiosity that drives you to find out how things work and if they can work better.
  • You value collaboration and feedback. You can communicate your vision in clear terms — to your peers as well as outside of your immediate team. You are willing and able to help your teammates grow by demonstrating best practices, providing (and receiving) respectful and constructive feedback, and sharing your unique insights with everyone.
  • You enjoy working in a fluid environment, defining and owning priorities that adapt to our larger goals. You can bring clarity to ambiguity while remaining open-minded to new information that might change your mind.
  • You are happy to fill in the gaps to reach a goal where necessary, even if it does not always fit your job description.
  • You have a genuine interest in what good technology can do to help people and have a positive attitude about tackling hard problems in an important industry.

You should get in touch if:

  • You are an MD or DO with a valid, unrestricted license to practice medicine in a US State.
  • You are Board Certified in Internal Medicine, Family Medicine, or similar speciality.
  • You have strong interpersonal skills and have experience managing provider relationships
  • You have clinical experience in primary care (required) plus additional clinical experience in home health or hospice (preferred).
  • You have experience leading / managing a practice for high-cost / high-needs patients.
  • You have experience managing value based contracts for a health plan and / or an ACO.
  • You have proficiency with computers/technology.

 

Pursuant to the San Francisco Fair Chance Ordinance, we will consider for employment qualified applicants with arrest and conviction records. We are an E-Verify company.


About Clover: We are reinventing health insurance by combining the power of data with human empathy to keep our members healthier. We believe the healthcare system is broken, so we've created custom software and analytics to empower our clinical staff to intervene and provide personalized care to the people who need it most.

We always put our members first, and our success as a team is measured by the quality of life of the people we serve. Those who work at Clover are passionate and mission-driven individuals with diverse areas of expertise, working together to solve the most complicated problem in the world: healthcare.

From Clover’s inception, Diversity & Inclusion have always been key to our success. We are an Equal Opportunity Employer and our employees are people with different strengths, experiences and backgrounds, who share a passion for improving people's lives. Diversity not only includes race and gender identity, but also age, disability status, veteran status, sexual orientation, religion and many other parts of one’s identity. All of our employee’s points of view are key to our success, and inclusion is everyone's responsibility.