Since its founding in 1967, OrthoIllinois, formerly known as Rockford Orthopedic Associates, has grown dynamically to become one of the leading bone and joint providers in northern Illinois. Our merger with Crystal Lake Orthopedics in 2013 allows us to provide exceptional care and expertise from four convenient clinic locations, two in Rockford, one in Crystal Lake, and one in Huntley, Illinois.

Our university-quality care delivery is founded on a one-stop, multi-specialty philosophy. This means you can expect the convenience of diagnosis, clinical care, diagnostic imaging, and rehabilitation therapy from one location – all under the direction of board-certified physicians who have sub-specialized in specific areas of orthopedic care. Whether your concern is arthritis, hand injury, fracture, sports injury, back, neck, foot, ankle, hip or knee pain, we have a specialist to focus on your specific need. Each physician has access to the most state-of-the-art technology and training to address each and every aspect of patient care.

Please visit our website at www.Orthoillinois.com.

GENERAL SUMMARY OF DUTIES: The Director leads the management of internal and external relationships related to functions within the Value Based Care and Case Management Department. The position oversees a mix of clinical, operational, and business activities related to Value Based Care, including but not limited to the BPCI partnership. The Director works closely across the care continuum, to facilitate coordination and standardization of care for our patients in the acute and post-acute setting. From a business perspective, this role is responsible for the overall performance of Value Based initiatives and associated staff. This position requires full understanding and active participation in fulfilling the requirements set forth for the programs, including the BPCI Program per CMS guidelines. This employee will also support overall strategic plans, goals, and direction of the quality improvement /process improvement activities of the organization.

ESSENTIAL FUNCTIONS: This position will coordinate and maintain administrative responsibility for oversight of OrthoIllinois’ participation in Value Based Programs and the Case Management Department, such as the CMMI Bundled Payments for Care Improvement Initiative; responsibilities may include oversight and responsibility for new commercial payor payment methods and protocols on behalf of OrthoIllinois.

ESSENTIAL DUTIES & RESPONSIBILITIES FOR POSITION:

1. Administrative responsibility for managing a group of Medicare orthopedic patients as part of the Bundled Payment Care Initiative (BPCI), and other commercial payor Value Based initiatives as needed.

2. Represent OrthoIllinois with various internal and external relationships including, but not limited to physicians, clinical teams, episode initiating hospitals and their staff, post-acute providers and their staff, and third-party administrators, and OISC ensuring all program expectations and requirements are met per applicable BPCI and/or alternative payment contracts.

3. Oversight, coordination, and monitoring of ongoing data analysis of CMS claims data and Facility/Group Quality Performance Target measures; including implementation of corrective action plan as needed.

4. Oversight and responsibility for new payment methods and protocols on behalf of OrthoIllinois.

5. Oversight, supervision of, and education of RN Case Managers within Value Based initiatives, including the BPCI Program.

6. Facilitation and oversight of Value Based Oversight Committees.

7. Development and implementation of Post-Acute Care (PAC) Provider Network, its metrics, and protocols to meet the goals of the program(s).

8. Oversight and administration of Case Management documentation system.

9. Collaborate with and education of multidisciplinary team members in the acute, post-acute and outpatient settings to create the process and set expectations of the health care delivery system throughout the course of care, AR, SNF, LTAC, Home Care, OISC related to the program(s).

10. Development of process, protocol and standardized care paths related to identified cases in collaboration with a multi-disciplinary team.

11. Identify gaps or barriers in treatment plans to ensure that discharged patients receive appropriate resources and services.

12. Maintain confidentiality of all patient information per HIPAA and OrthoIllinois guidelines.

13. Adhere to the scope of practice for the Registered Professional Nurse per state regulatory guidelines.

14. Administrative responsibility for gain sharing agreements

EDUCATION: Bachelor’s Degree or similar, required; Master’s Degree preferred

EXPERIENCE:

• 5+ years in a management role in a healthcare related industry
• 2-3 years of nursing experience in a hospital setting or telephonic case management experience preferred
• BSN Certified Case Manager or 5+ years of progressive Case Management experience preferred
• 2-3 years of Value Based program management preferred
• Experience with physician gainsharing preferred
• Experience in orthopedic management strongly preferred
• Demonstrated ability to lead and manage complex projects that are strategic in nature and scope
• Experience/knowledge of moving patients from acute to post-acute settings
• Excellent written and verbal communication and presentation skills for work with senior hospital executives, physicians, and vendors
• Data analysis skills, experience with performance measurement, outcome analysis, monitoring tools, and computer skills
• Demonstrated ability to complete projects timely and within budget
• Orthopedic experience preferred
• Strong problem-solving skills with a flexible and creative approach

All your information will be kept confidential according to EEO guidelines.