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Health Services Director - Connecticut (CareMore) # 134049 in Connecticut at Anthem, Inc.

Date Posted: 2/15/2018

Job Snapshot

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Job Description

Your Talent. Our Vision.  At CareMore, a proud member of the Anthem, Inc. family of companies specializing in providing high risk patients with a complete and proactive health care experience.  It’s the foundation upon which we’re creating greater care for patients, greater value for our customers and greater health for our communities. Join us and together we will drive the future of health care.

This is an exceptional opportunity to do innovative work that means more to you and those we serve. 

What is CareMore?

CareMore is entering a new growth phase, as a proven care delivery model for high-risk patients.  We are a team of committed clinicians and business leaders passionate about transforming American healthcare delivery.  We build and lead health plans and clinical teams to care for the most complex patients, serving over 100,000 patients in seven states across Medicare, Medicaid, and soon, commercial populations.  We strive for excellence and have achieved significant and measurable improvement in total cost of care, clinical outcomes, and experience.  We are looking for individuals who are passionate about disrupting the status quo in healthcare; who are highly motivated, focused, and can bring strong business skills to take CareMore to the next level of impact and growth. As an Anthem subsidiary, we benefit from the scale and resources one of America’s largest managed healthcare organizations.


The Health Services Director (Dir Health Services), CareMore (Connecticut) reports to CareMore’s General Manager and is responsible for ensuring the effectiveness of day-to-day clinical operations for  CareMore’s high-risk, home-based primary care model. The successful candidate will be responsible for building CareMore’s clinical operations from start-up through to sustainability and ongoing optimization. The role includes defining and operationalizing processes, tools, and systems that will support high-quality, effective, and efficient operations of CareMore’s home-based primary care model. In addition, the Director is responsible for geographic alignment of teams to best serve patients and develop relationships with healthcare stakeholders across health plan case management, community-based providers, and other collaborative community organizations.


Central to this work will be the ability to own and advance a portfolio of clinical operations initiatives from inception through delivery. Initiatives fall within an operational plan and include objectives across patient access and engagement; comprehensive care; and care continuity. The Health Services Director will work closely with peers in CareMore’s Primary Care and Collaborations division to gather and leverage best practice, while acting as a central coordination point within the mobile care team to help ensure clinical performance goals. The role requires a strong foundation in interdisciplinary team-based care, with experience in mobile care delivery and / or home care operations a plus. While the role does not require extensive payor (health insurance) operations experience, a foundation in care delivery operations for managed complex, senior populations such as Duals and / or Medicare Advantage is a plus.


Service areas will include New Haven and Hartford counties, and additional markets may be added as CareMore continues to grow.


Core Competencies:

  • Hands-on clinical operations experience (including team performance management and development; patient and community engagement; and mobile care delivery operations, among other functions), preferably managing in the primary care / outpatient setting, or in the home-based setting
  • Strong belief in and passion for CareMore’s comprehensive clinical model and care philosophy
  • Ability to work in an agile “start-up” environment, including the ability to drive results within ambiguous settings
  • Track record of building commitment to shared goals among teams with diverse skill sets
  • Ability to drive and maintain a far-ranging operational plan, including near- and long-term prioritization, KPIs, and visibility into tracking and results
  • A foundation in analytic tools to support measurement and assessment of key clinical improvement and process metrics
  • Demonstration of a continuous innovation mindset
  • Experience in managed care for complex populations (Medicare Advantage populations preferred)

Work location: New Haven and Hartford Counties, CT (50% Field-Based and 50% Office Estimated)

Position requires some travel to leverage best practice from existing CareMore markets and support General Manager in progress report-outs.

Essential Duties and Responsibilities
  • Manage the day to day operations, development and implementation of care planning through clinical support staff.
  • Provide oversight and use of reports to identify focus areas for action, training and improvement activity.
  • Manage processes for incoming patient calls, inventory of medical supplies, regulatory compliance regarding CLIA, Waste Disposal and compliance with HIPPA
  • Own and maintain a portfolio of  clinical operations initiatives and monthly dashboard
  • Administer home-based primary care logistics model (including scheduling of visit types and operational oversight for mobile care teams)
  • Lead and guide a team of clinical partners and case manager staff (~8 in year 1) to maximum performance
  • Drive clinical outcomes goals working closely with physician leadership in a manner that lives up to CareMore legacy and standards, as well as to deliver Medicare Advantage goals commensurate with CMS HEDIS and Quality expectations
  • Analyze operational data to uncover performance issues and leading the execution of improvement opportunities
  • Demonstrate leadership behaviors in accordance with CareMore’s values and culture 

Job Requirements

Minimum Qualifications
  • Requires a BA/BS; 7 years of related experience; or any combination of education and experience, which would provide an equivalent background.
  • Strong leadership and collaborative style people management skills preferred
  • Strong operations experience preferred
  • MHA or MPA or MBA is preferred.
  • 5 years of clinical practice in a hospital, clinic, home care, or nursing home setting preferred
  • 5 years of increasing supervisory or management experience in a health care setting preferred
  • Familiarity with quality indicators and cost of care analysis preferred
  • Hands-on, high-energy and willingness to do what it takes to get the job done preferred
  • Ability to communicate effectively at all levels inside and outside the organization preferred
  • Proficient in MS Office including Word, Excel, PowerPoint and Outlook Calendar preferred
  • Excellent project management skills preferred
  • Travel required

Other Experience is a Plus but Not Required:  

  • Medicaid and Dual Eligible experience is a plus, but Not required
  • Case management experience is a plus, but Not required
  • Health plan experience is a plus, but Not required
  • Disease and utilization management experience is a plus, but Not required

Anthem, Inc. is ranked as one of America’s Most Admired Companies among health insurers by Fortune magazine and is a 2017 Diversity, Inc magazine Top 50 Company for Diversity. To learn more about our company and apply, please visit us at EOE. M/F/Disability/Veteran.