Provider Partners · 3 months ago
Chief Clinical Officer
United States
Full-time
Remote
Director/Executive
10+ years expProvider Partners is a value-based care company focused on improving quality outcomes for residents of various senior living facilities. The Chief Clinical Officer (CCO) will lead the clinical vision for the organization’s Medicare Advantage plans, overseeing clinical programs and ensuring high-quality, person-centered care while managing affordability and compliance.
Assisted LivingHealth CareNursing and Residential Care
Responsibilities
Develop and implement the clinical strategy for the I-SNP, aligning with organizational goals and financial sustainability
Serve as the clinical subject matter expert to the CEO, Board of Directors, and executive leadership team
Drive innovation in care delivery models, risk adjustment optimization, and affordability initiatives tailored to the needs of institutionalized members
Oversee care management, utilization management, and interdisciplinary care team programs to improve health outcomes and control costs
Ensure timely and accurate completion of HRAs and ongoing documentation to support comprehensive risk adjustment
Collaborate with network providers and facility partners to optimize care quality and reduce unnecessary utilization, including avoidable hospitalizations and emergency visits
Monitor provider performance, clinical outcomes, and total cost of care, implementing corrective actions and improvement initiatives
Lead clinical risk adjustment strategy, ensuring complete and accurate coding and documentation of members’ conditions
Partner with finance to align clinical programs with revenue optimization and compliance requirements
Develop and oversee affordability strategies, including medical cost management, value-based care initiatives, and collaborate with pharmacy on drug utilization oversight
Ensure care models balance high-quality outcomes with sustainable financial performance for the plan
Drive quality improvement initiatives to achieve CMS Star Ratings, HEDIS, CAHPS, and other key benchmarks
Ensure compliance with all CMS regulations, NCQA standards, and state requirements governing SNPs
Co-Chair the Quality Improvement Committee and other clinical governance bodies
Oversee population health programs focused on identifying and managing high-risk, high-cost members
Champion member experience by ensuring care is goal-directed, culturally competent, and person-centered
Build strong partnerships with providers and facilities, offering education and support on risk adjustment, affordability, and quality measures
Engage providers in value-based arrangements to align incentives with quality and cost outcomes
Lead, mentor, and develop clinical staff, including nurse practitioners, care managers, and medical directors
Promote a culture of accountability, compliance, and continuous improvement
Ensure clinical teams understand and contribute to risk adjustment and affordability strategies
Qualification
Required
MD, DO, NP, or PA with active, unrestricted license; board certification preferred
Minimum 10 years of clinical leadership experience, with at least 5 in managed care, Medicare Advantage, or long-term care
Strong knowledge of CMS Medicare Advantage regulations, risk adjustment (HCC coding, RAF scores), affordability strategies, and quality programs
Proven ability to manage medical costs while improving member outcomes and satisfaction
Data-driven leader with experience using analytics to drive clinical and financial performance
Exceptional leadership, communication, and relationship-building skills
Preferred
Demonstrated expertise in I-SNP, Special Needs Plans, or institutional care models strongly preferred
Company
Provider Partners
Provider Partners is a leader in tech-enabled value-based care solutions, purpose-built for long-term care.
201-500 employees
Funding
Current Stage
Growth StageTotal Funding
unknown2020-01-01Series Unknown
Leadership Team
Keith Persinger
CFO & COO
Ellie Brooke-Beckett
Director, Strategic Partnerships
Company data provided by crunchbase