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Clinical Manager, SCO Care Management

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POST DATE 9/8/2016
END DATE 11/22/2016

Tufts Health Plan Watertown, MA

Watertown, MA
AJE Ref #
Job Classification
Full Time
Job Type
Company Ref #
Mid-Career (2 - 15 years)
Bachelors Degree


Under the administrative direction of the Director, the for Senior Care Options (SCO) is responsible for the oversight and monitoring of care management functions and the delivery of defined metrics to ensure adherence to clinical quality, compliance metrics, and clinical model delivery. They will also have direct oversight and responsibility over the Aging Services Access Point (ASAP) Performance Consultant team and will be accountable for the clinical performance of these delegated entities. In addition, the SCO Clinical Manager will be expected to collaborate with the Manager of Clinical Operations to develop and refine an evidence based geriatric-focused care management program to support the SCO and CM/PCP care teams across the network.

The SCO Clinical Manager is a member of the Care Management (CM) leadership team which includes the Manager of Clinical Operations, the ASAP Performance Consultants, the SCO Quality Manager, and the SCO Care Management Supervisor(s). This team closely collaborates to develop processes, workflows, and reports and is responsible for the development and implementation of the SCO clinical model.

The SCO Clinical Manager works collaboratively with other members of the SCO CM Leadership team, SCO Medical Directors and other appropriate Tufts HP staff in order to meet the corporate and/or program goals of the SCO program. The SCO Clinical Manager will lead a team including but not limited to: Nurse Care Managers, ASAP Performance Consultant(s), Complex Care Clinician(s), and Social Worker(s). The manager is accountable for recruitment, evaluation, management and development of program staff and other applicable staff within her/his jurisdiction.


Essential Job Functions

Business Process Implementation and Oversight
Accountable for the development and implementation of the SCO clinical model and for the performance of the care management team, including the ASAP staff, in respect to meeting quality and compliance metrics and validating business unit/program effectiveness. Also responsible to develop and implement processes and procedures to support the adherence to the clinical model and identified condition/disease management programs. To support the execution phase of the care management program, the SCO Clinical Manager will act as a clinical consultant to the care managers and supervisor(s) on individual cases and identify additional opportunities for growth and development of the clinical team. These responsibilities include, but are not limited to:

Oversight and monitoring of the day-to-day care management functions.
Collaboration with the SCO CM leadership team to monitor/manage /develop /implement clinically focused programs/initiatives to improve performance.
Collaboration with the Manager of Clinical Operations, ASAP Performance Consultant(s), Clinical Supervisor(s), and Business Analyst to develop and refine all necessary reports to meet regulatory requirements, quality metrics, and staffing needs.
Work with the Complex Care Clinician(s) on HCC coding initiatives and supporting the palliative care program.
Work collaboratively with other members of the SCO CM Leadership team, SCO Medical Directors and other appropriate Tufts HP staff to identify and address opportunities to manage utilization, improve quality, identify gaps in knowledge or services, reduce administrative cost and demonstrate outcomes for clinical, financial and utilization functions and programs.
In collaboration with the Manager of Clinical Operations and Clinical Trainer, provide input into the development of a SCO orientation and training program, as well as tools and resources.
Ongoing communication and partnership with Network Contracting and Allied Health departments to develop and implement strategies to optimize the critical relationships with our community partners (physicians, ASAPS, health care facilities, vendors, etc.)
Facilitation of the development and revision of written policies/procedures and workflows pertaining to SCO care management activities.
Collaboration with Manager of Clinical Operations and other internal TMP departments to increase efficiency to maximize operational output.
Directly responsible for the integration of existing and future clinical geriatric programs (such as the palliative care program) into the care management model.

General Management/Staff Support and Development
Hire and retain staff
Maintain a performance management system for overseeing staff performance
Coach and develop staff
Organize and facilitate team meetings as appropriate
Champion change and effectively manage the implementation of new ideas
Participate in organizational planning and projects

Resource Management
Oversee the management of department resources
Support realization of department administrative budgets

Corporate Participation
Represent SCO Clinical Care Management in relevant corporate teams as required
Implement and support fulfillment of corporate objectives within scope

Education Requirements:
Bachelors of Science in Nursing (BSN) and Registered Nurse with current, unrestricted state licence is required, Advanced Practice Nurse with current, unrestricted Massachusetts license preferred.

* Minimum 3-5 years clinical nursing experience required.
* Past experience in Medicare and/or Medicaid managed care required.
* Experience in managing geriatric/chronic illness populations and/or direct care of inpatient/ambulatory geriatric/chronically ill population required.
* 5-7 years experience managing and leading a team required.
* Experience managing within a SCO program highly preferred
* Prior home care experience preferred

Skill Requirements:
* Must work cooperatively as a team member across multiple levels within the organization
* Excellent communication skills and demonstrated ability to build collaborative relationships
* Demonstrates skill in financial/business acumen
* Critical and Analytic thinking -- must understand cause and effect, internal and external impact of business changes and SCO information systems
* Influencing others -- particularly those outside of direct reporting relationships
* Coaching and Mentoring - primarily of direct reports, but also of others
* Must have commitment to excellence in customer service
* Considers creative alternatives to traditional/conventional practices and takes risk when appropriate to the situation.
* Regard for confidential data and adherence to corporate compliance policy
* Ability to handle multiple demands--must be able to balance multiple priorities

Other Requirements:
Fast paced office environment handling multilple demands and exercising appropriate judgement when necessary. Some occasional local travel will be required to meet with external customers. Must have the ability to travel or transport self and/or team members to/from business meetings. Ablility to learn and comply with company policies consistently and seeking out guidance when necessary is required.

Equal Opportunity Employer Minorities/Women/Protected Veterans/Disabled


Founded in 1979 as a non-profit health maintenance organization (HMO), Tufts Health Plan is one the country's largest HMO offering a full array of healthcare coverage options to individual consumers and employer groups. Tufts Health Plan has received high marks for its quality from a variety of third parties including U.S News & World Report and Newsweek.