Wilmington Health · 17 hours ago
ACO Operations Director
Wilmington, NC, US
Full-time
Onsite
Lead/Staff, Director/Executive
3+ years expWilmington Health is a multi-specialty medical practice dedicated to community health in Southeastern North Carolina. The ACO Operations Director will oversee the day-to-day operations of client groups in Accountable Care Organizations, focusing on governance, communication strategies, and quality initiatives.
Health CareHospitalMedicalWellness
Responsibilities
Maintains knowledge regarding ACO policies and procedures, governance structure and regulatory requirements through ongoing research and regular attendance at training webinars
Utilizes standard project management tools and principles to define and manage project scope, monitor timelines and deliverables, and communicate and identify pathways to resolve risks and barriers
Oversees and maintains effective communication with stakeholders using communication plans, status reports, dashboard and various media sources tailored to the audience
Effectively plans and facilitates meetings of varied participants using standard meeting management tools and techniques (e.g. agendas, meeting roles, ground rules, minutes, action item tracking) including support of meeting logistics for ACO Boards and committees
Leads process improvement, new workflow development, enhancement through support of and collaboration with practices to drive performance on contract quality and equity metrics
Works collaboratively with practices and providers to develop campaigns to address gaps in care, monitors patient and practice/provider compliance with campaigns and provide feedback and adjustment as needed to ensure success
Leads planning efforts to enable the Block Ops team to effectively achieve high performance in risk-based contract quality and equity metrics and ensure compliance with regulatory agencies
In collaboration with the WH ACO and analytics teams, develops comprehensive operation for clinical data acquisition, reporting, and workflow development in support of quality measure improvement
In collaboration with local leaders, informs the redesign of local workflows to drive performance in quality and equity metrics
The Compliance Officer will create, maintain, and audit the ACO’s Compliance Plan and provide regular reports to the Governing Body of the ACO
Establish and maintain a method for employees or contractors of the ACO, its ACO Participant Provider and Preferred Providers, and other individuals or entities performing functions or services related to ACO Activities or Marketing Activities to anonymously report suspected problems
Work with the Wilmington Health Compliance Officer to receive claims analysis to identify potential fraudulent behavior or program integrity risks, such as inappropriate reductions in care, effort to manipulate risk score or aligned populations, overutilization, and cost-shifting to other payers or populations
Audit chart, medical records, Implementation Plans and other data from the ACO, its ACO Participant Providers and its Preferred Providers
Cooperate with all CMS monitoring and oversight requests and activities
Ensure compliance with all applicable state licensure requirements regarding risk-bearing entities in each state in which the ACO operates
In a form and manner and by a deadline specified by CMS, the ACO shall submit to CMS documentation demonstrating its compliance with the requirement set forth in the Agreement
Ensure compliance with all plans submitted to CMS for benefit enhancements or waivers
Ensure that the ACO has appropriate procedures in place to ensure that ACO Participant Provider and Preferred Providers have access to the most up-to-date information regarding Beneficiary alignment to the ACO
Qualification
Required
3+ years' experience in healthcare, with value-based care models (CMS MSSP, ACO REACH, Commercial full or partial risk contracts)
Demonstrated understanding of healthcare clinic models, HEDIS measures, STAR ratings, documentation processes, and strategies to close gaps in care and support caring for high and rising risk patients with multiple chronic conditions
Strong expertise with MS Excel, MS Teams, and PowerPoint
Preferred
5+ years' in healthcare operational management
Demonstrated understanding and experience with SQL queries and analytics, understanding of risk stratification models, and the ability to translated data-driven insights into clear clinical priorities and interventions
Bachelor's Degree in Healthcare or Business Administration
Company
Wilmington Health
Wilmington Health provides a comprehensive health care services including primary health care and surgery for the community.
501-1000 employees
Funding
Current Stage
Late StageLeadership Team
Jeff James
Chief Executive Officer
Suzy Kearns, CPA, CHC
Chief Financial Officer
Recent News
Fierce Healthcare
2025-04-18
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