DIRECTOR OF POPULATION HEALTH (EXEMPT)

COMMUNITY HEALTH OF SOUTH FLORIDA INC•The Hammocks, FL

1d•$80,000 - $97,000

About The Position

The Director of Population Health provides direction and oversight for value-based programs, including Population Health, CARES, and internal credentialing. The role manages program applications, onboarding processes, care coordination services, and the development and deployment of performance-maximization strategies. The director develops and maintains relationships with managed care organizations and MSOs and oversees population health, care, and credentialing services with assistance from the AVP of Population Health. The director oversees VBS/HEDIS medical record collection and abstraction, provider performance assessment, care management operations, departmental staff, and compliance with ACO and MSO requirements and metrics. The position supports implementation of the Care Management Program and identifies opportunities to improve patient care, quality, customer service, financial performance, and regulatory compliance. This role also provides strategic and operational oversight of provider credentialing and privileging, payer enrollment coordination, and related compliance, reporting, and risk-mitigation activities. The director works with internal leaders, providers, managed care organizations, external facilities, and community agencies. The posting describes additional responsibilities involving HIV/AIDS education and prevention, quality assurance, and performance improvement.

Requirements

Associate degree or higher from an accredited college or university in a health-related field is preferred.
Five years of experience in a health care or related setting.
At least two years of experience in clinical care management.
Experience working with culturally diverse clients.
Knowledge of managed care program incentives and requirements, including HEDIS, Pay for Performance, Medical Loss Ratio, and utilization.
Current CPR certification from the American Heart Association.
Valid Florida Driver’s License.
Excellent communication and interpersonal skills, including sensitivity when working with diverse cultural groups.
Ability to solve problems, develop solutions, work independently and as a team member, and adapt to changes in work schedule and assignments.
Strong computer skills and data-entry ability.
Knowledge of medical and managed care terminology; Medicare, Medicaid, and managed care coverage benefits and limitations; NCQA VBS/HEDIS requirements; and ICD-10 and CPT coding.
Ability to prioritize, multitask, meet goals and deadlines, stay organized, and maintain attention to detail.
Ability to read and interpret medical documents and track, manage, document, identify, and report patient data.
Ability to work in a high-production environment and meet measured productivity requirements.
Ability to maintain confidentiality and comply with HIPAA regulations.

Nice To Haves

EPIC Healthy Planet experience.
Basic computer knowledge is preferred.

Responsibilities

Direct value-based programs, including Population Health, CARES, and internal credentialing, and oversee program applications, onboarding, care coordination, and performance strategies.
Develop and maintain relationships with managed care organizations and MSOs; serve as a primary contact for value-based contracted business.
Oversee VBS/HEDIS medical record collection and abstraction, assess provider performance against applicable standards, and ensure compliance with ACO and MSO requirements and metrics.
Provide administrative oversight for VBS and care management staff and direct care management operations, including quality, customer service, financial performance, and regulatory compliance.
Implement care management activities and identify opportunities to improve patient care.
Monitor contractual performance, financial and quality targets, provider reimbursement, incentives, risk-bearing arrangements, utilization, and performance gaps; develop action plans and report results to leadership.
Coordinate patient appointments for health risk assessments, preventive visits, chronic care management, and transitions of care.
Support clinical and operational initiatives to improve quality, reduce avoidable utilization, improve coding and documentation accuracy, and manage value-based program attribution.
Collaborate with clinical, finance, pharmacy, quality, and other leaders to develop programs and improve departmental performance.
Prepare reports for committees and leadership; monitor department metrics, patient outcomes, quality measures, productivity, and action items.
Develop workflows, policies, procedures, and protocols; support staff onboarding, training, accountability, and performance improvement.
Oversee provider credentialing and privileging, including application processing, reappointments, renewals, primary-source verification, credentialing files, data accuracy, and expiration tracking.
Coordinate credentialing with payer enrollment, HR, risk management, revenue cycle, external facilities, and medical staff offices; ensure alignment with payer activation, provider status, scope of practice, and privileges.
Oversee credentialing compliance with accreditation standards, regulations, health plan standards, CMS requirements, internal bylaws, HIPAA, and organizational policies.
Serve as a liaison for credentialing inquiries, audits, surveys, and reviews; prepare documentation and reports and communicate credentialing status and requirements to providers and stakeholders.
Support risk mitigation by identifying credentialing-related risks and resolving documentation, enrollment, and billing discrepancies.
Support FTCA Deeming and Redeeming documentation and provider eligibility; monitor sanctions, exclusions, and reportable events.
Oversee HIV/AIDS prevention education and related community, patient, and employee education activities described in the posting, including coordination with community agencies.
Participate in quality assurance and performance-improvement activities, review analytics and quality measures with direct reports, and support development of clinical practice guidelines and strategies.
Publish HEDIS gap and productivity reports, support posting Category II performance measures, and ensure hospital discharges are addressed appropriately.
Maintain confidentiality and HIPAA compliance, attend required meetings and training, follow organizational policies, and perform other duties as assigned.