Care Management Development and Delivery Lead
Crossover Health
 San Clemente, CA

About Crossover Health

Crossover makes remarkable health possible by bringing people, their doctors, data, and benefits together under one connected system of health. We've built an entirely new category of primary care providing one simple place to go for trusted care—in person, online, anytime. We are working with the most innovative employer partners to integrate disconnected health and wellness benefits with tech-enabled services which allows our partners to increase access to care, decrease healthcare spend, and deliver an unrivaled experience for employees near and far.

Care Management Initiative at Crossover

Crossover is in the process of designing and building a Care Management service offering for delivery to our clients and prospective clients starting in 2020. Care Management at Crossover includes Care Management as well as Condition Management and Case Management coaching services. Condition Management will help members struggling to manage their chronic diseases (asthma, diabetes, COPD, CHF, CAD). Crossover will be assisting those at highest risk better manage their disease to reduce the need for healthcare. Case Management will assist those members struggling with multiple comorbidities, complex and/or catastrophic health conditions as well as those who have or are expected to be “large claimants.“ The Condition and Case Management coaching will be delivered through Crossover's virtual / online offering as well as telephonically. It will include working with members to create and manage care plans / actionable steps and goals. It involves working with the member's families, physicians, ancillary service providers, and others involved in the member's care.

Job Responsibilities

The person who fills this role will lead the development and delivery of the Care Management coaching service offering. This includes overseeing the development of all people, processes and technologies needed to deliver this new offering. This person will bring industry best practices to Crossover to facilitate the building of a world-class solution.

Develop the Service

With the support of Crossover Product Development, Clinical Operations, Business Intelligence, Sales, Project Management and Technology teams, lead the development of the overall solution functionality including:

  • Identification criteria for selecting potential candidates coaching
  • Engagement processes and tools to reach out and engage candidates in the coaching program
  • Screening criteria to determine if coaching is applicable / necessary for each candidate
  • Care Plan creation and management to personalize the health strategy for each engaged member
  • Clinical workflows for managing care plans and working with members once engaged, utilizing the Crossover multidisciplinary care teams to ensure seamless provision of care
  • Tracking of results, including health improvement, compliance improvement, and cost savings generated on individuals and populations
  • Identifying the functionality release strategy to ensure timely go-to-market while phasing in capabilities and features of the end-state solution

With support from the Crossover teams listed above, define the support structure needed to deliver the solution. This includes:

  • Personnel needs - roles, job descriptions, training needs, ramp-up, ratios for delivery
  • Physical locations of coaches and how they integrate with or are separate from existing clinics
  • Necessary accreditation's (URAC, NCQA, etc.) and licensing for the service and delivery staff

Deliver the Service

Once developed, Crossover expects the Care Management coaching service will be a Crossover “Guild“. Current Guilds include Physical Medicine, Primary Care, Nursing, Optometry, Behavioral Health, Health Coaching, and Host. These services align in their solution delivery across clinics.

  • Contribute to Planning for Guild. Partner with Guild Director and Chief Medical Officer to set goals for clinical growth and development of the specialty. This includes meetings, annual plans and objectives and return on investment.
  • Advise on Implementations. Partner with project management and clinical operations team in the implementation of the services for new clients. Work to ensure integration of the Care Management service line, delivery of full value, and availability as needed.
  • As we are ramping up Care Management client sales, this role may fill an active coaching spot to deliver services to our first client(s).

Required Qualifications

  • Minimum 2-3 years of Care Management service development and/or leadership experience
  • Minimum of 1-2 years experience in program development
  • Current Basic Life Support (BLS) for healthcare providers
  • Demonstrated ability to provide excellent care over digital communication channels including video conferencing, telephone, secure messaging, chat-based communication, and asynchronous care.

Preferred Qualifications

  • Graduate of an accredited school of nursing with a current valid RN license in all states where the defined population of members resides. Currently needs to be licensed in CA with willingness to obtain other licenses as needed.
  • Minimum of 5-7 years clinical nursing experience (primary care, emergency, outpatient, or urgent care preferred), preferably in an integrated clinical setting.
  • Experience working with populations in remote geographies, including steerage into community networks and partnerships with local resources.
  • Proven comfort with a variety of technology platforms including Google suite, video conferencing software, CRMs, EMRs, etc.
  • Ability to analyze and make critical thinking decisions.
  • Passionate about delivering the best patient care possible, strong work ethic and takes pride in their work.
  • Takes initiative to develop new workflows and procedures, highly organized, and flexible when priorities change. Instinctively goes above and beyond for members and the practice and is comfortable in working with both care team and independently.

Physical Job Requirements

  • Ability to work on location with designated care team members at a Crossover Health virtual practice site 80% of the time (this is not a remote position, only the patients are remote).
  • Ability to travel 20% of the time