Caritas Christi Network Services (CCNS) is the Management Service Organization (MSO) serving the 1,100 affiliated physicians of all specialties spread over Caritas’ entire geographic span.  About 700 of these physicians practice independently as part of one of seven Caritas-affiliated IPAs, and 400 are directly employed through the Caritas Physician Network (CPN) and are also members of their respective IPAs.  Many prominent physicians have been attracted to CCNS in the past year. 

CCNS is responsible for implementing and managing the payor contracts for the physician network and for providing programs and services to assistant the network in being successful with its contracts.  CCNS currently has contracts with all the major health plans in Massachusetts and recently signed an Alternative Quality Contract with Blue Cross/Blue Shield in which Caritas assumes financial risk in managing resources and care. 

Still a relatively new organization, CCNS has grown from 2 to 18 employees in the past 18 months with plans for future expansion.  Current functions provided within CCNS include, Case Management, Referral/Authorization, Pharmacy Management, Quality Performance, Contract Operations, Analytics, and Finance.

The Senior Medical Director is responsible for the development and implementation of the overall medical management strategy and performance programs for CCNS and for leading IPA-based Medical Directors across the CCNS system to transition CCNS to a leading community based Accountable Care Organization.

This position will have a leadership role in all aspects of the CCNS system, including responsibility and accountability for:

• Lead/Mentor/Support IPA based Medical Directors (at both the IPA and Pod level) to achieve Medical Management goals and objectives in Quality, Leakage, Utilization, and Risk performance
• Establish medical management and performance goals and objectives based on system goals and communicates these goals and objectives across CCNS, to direct reports, and to Board
• Develops, implements and coordinates the Pay for Performance and Risk Performance Programs, reviews risk budgets and risk performance of  IPA and provider groups.
• Leads teams in the development and execution of IPA specific Medical Management and performance action plans to improve both system and IPA performance
• Lead Medical Management efforts for CCNS to achieve and maintain FTC certification for Clinical Integration
• Lead Medical Management efforts for CCNS to achieve and maintain CMS certification as an ACO
• Lead  Medical Management efforts for CCNS to achieve and maintain Delegation status with major payers
• Develops and implements case management and referral management programs.
• Establishes medical practices and guidelines for CCNS providers for care consistent with HMO and community based medical standards
• Documents and communicates medical policy to CCNS providers and staff.           
• Ensures medical management program goals are linked to achieving corporate goals and objectives.
• Ensures medical management program activities are performed in a cost effective, productive and timely manner, either by in-house staff or by contracted personnel.       
• Assists the President and senior staff in developing policies to be recommended to the CCNS Board
• Develops plans, systems and methodologies to implement policies approved by the CCNS Board, and communicates these plans, systems and methodologies to the CCNS staff.
• Lead development of decision support systems and care guidelines
• Collaborates with hospital based Case Management, Referral Management and other program directors and managers, to ensure that  members, providers, hospitals and others who transact business with the CCNS staff are provided with effective, efficient, and courteous service at all times.
• Maintain strict controls over department budgets; reviews variances and takes effective action. Maintains control of contract arrangements; reviews provisions of the contracts at regular intervals and recommends changes or enhancements if deemed necessary.
• Keeps the President, and senior staff and CCNS Board informed of all significant developments within or outside the company that may have or has had an impact on company operations.
• Reviews audits, utilization reports, patterns of practice and make recommendations to correct problems identified.  Establishes standards for review and distribution of data to the IPAs.
• Chairs the Medical Mgt Committee and coordinates activities of local Medical Directors.
• Has input into establishment of credentialing policies and procedures.
• Attends meetings with payors and other third party organizations as needed.
• Assist in the resolution provider grievances and other provider service issues.

Requirements

• Board Certified Physician in Primary Care Specialty. 5-10 years experience in a managed care leadership role in a large physician organization and/or HMO.  
• Current Massachusetts licensure required.  
• Possesses strong clinical background in acute or post acute settings with focus on the delivery of high quality and cost effective care
• Demonstrates ability to apply principles of critical thinking.
• Possesses strong interpersonal written and oral skills
• Possesses excellent time management skills with proven ability to effectively manage multiple tasks and priorities at one time.
• Demonstrates knowledge of managed care concepts for various health plan and capitated programs.
• Collaborates with multiple providers to provide quality and cost effective care for risk members.
• Accepts flexibility in work schedule willingly. (e.g. periodic evening meetings with potential for evening and weekend beeper coverage assignment.)
• Requisite poise, judgment, and trustworthiness to represent CCNS to internal and external groups
• MS Office, Powerpoint, Excel

Caritas Christi is an equal opportunity employer.

Norwood Hospital, a 264-bed facility, is a member of Caritas Christi Health Care, the second largest health care system in New England.  Norwood Hospital is located in Norwood, Massachusetts.  It houses the full range of patient care services, from its Small Miracles Family Birthing Center to its modern emergency department, up-to-date radiation oncology services, extensive endoscopic services, advanced laparoscopic and neurological surgery and cardiac catheterization lab.

It is the goal of Norwood Hospital to provide exceptional care to the more than 300,000 people in Norwood and the 16 surrounding communities.

The city of  Norwood  is conveniently located only 30 minutes from  Boston, Massachusetts  &  Providence, Rhode Island

Gene Dwiggins - Providence Tiled Photo Collection