Care Transformation Coach

Horizon Blue Cross Blue Shield of New Jersey•Newark, NJ

4d•$87,300 - $119,070•Onsite

About The Position

The Horizon care transformation team is responsible for working directly with providers of care to implement and sustain innovative programs that emphasize value-based care within the Healthcare delivery system in New Jersey. The transformation team works in a hands-on manner to support Horizons Value-Based programs, provide exceptional service to the customer and contain medial claims cost. The Care Transformation Coach will support Horizons Value-Based programs by facilitating and tracking the transition of multidisciplinary internal and external healthcare teams against established requirements and standard processes, by working internally to enhance these programs and externally to facilitate program implementation. Serves as a resource for and advisor to healthcare providers and Horizon staff from all departments.

Requirements

High School Diploma/GED required.
Bachelor degree in Healthcare Management or related field preferred or relevant experience in lieu of degree.
Requires minimum five (5) years clinical experience in a healthcare setting: health plan, hospital, physician practice.
Prefer an RN, Licensed clinical social worker, or Master of Public Health.
Requires direct experience with disease management/preventative management programs/population health.
Requires direct experience with using data analysis to drive population health management and process improvement.
Requires experience in continuous quality improvement/quality management/rapid cycle improvement.
Requires direct experience with behavioral coaching or motivational interviewing preferred.
Prefer project management experience
Requires an active NJ Drivers License
Requires basic knowledge of health plan activities including Utilization Management (UM), the CCM process and Disease Management/Population Based CM, basic claims processing, contracting and enrollment - Requires knowledge of health care systems, practice and hospital based care delivery, fundamentals of population health, value based payment models and medical documentation.
Proven ability to influence without authority and the ability to achieve results through others in a decentralized organization without formal reporting relationships.
Strong facilitator skills in leading cross-functional teams to achieve improvements and taking initiative to finding solutions to difficult or sensitive problems, including asking probing questions.
Requires effective, professional communication skills both verbal and written.
Strong public speaking and presentation skills.
Requires excellent interpersonal skills and ability to work with all levels.
Requires project management skills.
Must be proficient in use of personal computers and supporting software in a windows based environment including MS Office Products (Word, Excel, Outlook, PowerPoint).
Strong organizational skill and ability to set priorities.
Innovative, critical thinker and problem solver.
Flexible and adaptable to change.
Works well independently as well as in a team environment.
Exercises sound judgment.
Takes initiative in finding solutions to difficult situations and addresses challenges.

Nice To Haves

Licensed RN or SW preferred

Responsibilities

Performs data interpretation and analysis, performance reviews and readiness assessments to determine strategies, workflows and tactics to result in care transformation to meet performance indicators and achieve the triple aim.
Designs high-quality action and/or project plans to drive value-based initiatives, including the development of projects to support strategic partners with the identification of needs, project implementation, monitoring and refinement.
Focuses strategically with stakeholders to assist with the identification and prioritization of goals to enhance care delivery, cost reduction and improve quality.
Chairs or participates on specific internal and external core teams and/or work streams to offer background expertise to support transformation efforts for strategic partners.
Leads the creation and facilitation of individual, customized Value-Based trainings, including in-services, Webinars. Offers train the trainer sessions to expand transformation activities across a broader audience.
Creates and facilitates the appropriate use of educational materials considering health literacy for internal and external partners (e.g. Value-Based programs, motivational interviewing, etc.) to drive learning collaboration and healthcare delivery transformation to focus on population health.
Develops and implements the use of customized tools to support performance improvement.
Examines and conveys data, project findings/results and action plans to internal and external stakeholders.
Utilizes best practices to collaborate and optimize continuous improvement processes among Value-Based partners.
Works and builds upon collaboratively with internal and external stakeholders to identify cultural change needs that can support synergy among the value-based programs.
Participates with internal and external teams to develop and communicate key performance indicators to monitor adherence to best practices and achievement of member outcomes.
Maintains superior relationships with various strategic partners, including health care providers, facilities and other health care stakeholders throughout New Jersey. Interaction with partners may occur at all levels within an organization including physicians, nurses and executives.
Champions collaborative cross-departmental and cross-team environment and communication between transformation teams and other Horizon departments, including health affairs, network management, sales, analytics and government programs.
Utilizes clinical best practices, based on research, national pilots and Horizon experience, for internal teams and external customers.