Director of Value Based Care Strategy & Leadership - ProHealth Physicians, a part of Optum Connecticut

Change Healthcare • Farmington, CT

121d • $132,200 - $226,600

About The Position

Explore Opportunities with ProHealth Physicians, part of the Optum family of businesses. When you work at ProHealth Physicians, your contributions directly sustain the health and well-being of our community. Discover high levels of teamwork, robust medical resources and a deep commitment to exceptional care and service. Join a leading community-based medical group and discover the meaning behind Caring. Connecting. Growing together. ProHealth Physicians, a part of the Optum family of businesses, is seeking a motivated Director with a firm foundation and understanding of value-based care and population health. This candidate should be a strategic high-level thinker who can analyze opportunities to improve operations, craft new strategies within, and implement new findings across all teams that will yield continued collaboration and future growth within the business line. As a member of ProHealth Physician's leadership team, the Director of Value Based Care will be responsible for operations and business functions that support clinical quality and affordability efforts. Working in a dyad relationship with the Medical Director of Value Based Care, this leader will foster cross-functional and system-wide relationships acknowledging that every member of the clinical team is responsible for quality and affordability. This position recognizes the critical linkage between organizational efforts to improve quality and ensure affordability. The leader will work closely with various clinical, operations and business leaders across ProHealth and should be familiar with and able to lead teams working on Quality, Affordability, and Risk Adjustment to maintain coordination and maximization of success. In aggregate, the leader will ensure operational and business rigor through identification of unleveraged affordability opportunities, clinical quality performance improvement areas, and medical cost trend drivers that deliver cost management and improved clinical outcomes for patients. The Director of Value Based Care will engage with the clinical and business leaders to represent the market's needs and lead efforts to grow the culture of high-quality affordable care in the state of Connecticut. This is a full-time (1.0 FTE) position reporting directly to the Chief Medical Officer. You'll enjoy the flexibility to work a possible Hybrid schedule, you must be located within the State of CT, or easily commutable to Farmington, CT as you take on some tough challenges.

Requirements

• Proven skills and experience typically acquired through at least 10+ years of healthcare operational and business management experience in progressively responsible roles, including at least 5+ years in high level clinical operations management preferably in an outpatient medical group practice environment focusing on value-based care and population health management.
• Experience working with a large physician group, managing through influence and collaboration.
• Supervisory experience over administrative and clinical staff.
• Proven knowledge of applicable federal and state laws and regulations related to the health care industry.
• Experience presenting to C-Suite leadership.
• Demonstrated solid business acumen and a deep understanding of financial impacts of medical management operations and performance.
• Proven solid organizational and analytical skills with the ability to drive awareness, connectivity, and performance improvement.
• Ability to use data and financial literacy to inform value-based care initiatives, clinical quality, and experience strategies.
• Ability to exhibit a patient-centered mindset.
• Ability to influence without authority, work in a highly matrixed environment and build relationships at all levels in the organization.
• Possess/acquire an in-depth understanding of Optum service delivery model, operations, and products/solutions.
• Proven excellent verbal and written interpersonal communication skills.
• Ability to leverage relationship management skills.

Responsibilities

• Keeps current on emerging trends around value-based care, quality, and medical spend along with developing a deep understanding of current initiatives and performance in the market.
• Collaborates with clinical, operational, and financial leaders to evaluate opportunities and improve processes that enable effective implementation of value-based care initiatives and drive performance on quality and cost.
• Identifies and manages the risk stratification of the population to ensure those at highest risk are connected to key resources to improve quality, ensure health equity and lower cost of care.
• Establishes an accountability framework for value-based care to drive consistency and propagate best practices across the market to produce consistent and repeatable clinical quality and lower medical expense.
• Sets annual goals and key performance indicators (KPI's) for important measures in quality and affordability in partnership with the ProHealth Leadership team.
• Monitors, tracks, consolidates, and communicates the market impact of quality and affordability initiatives to provide standardized and comprehensive performance updates.
• Monitors actual performance, compares to established benchmarks and recommends corrective actions.
• In partnership with the Medical Director of Value Based Care, sets the agenda for health equity in the market, identifying opportunities and executing tactics to improve equitable care for all ProHealth patients.
• Drives increased awareness of the progress and effectiveness of ProHealth quality and affordability initiatives across the organization.
• Leverages data and analytics to identify trends, finds new opportunities, and/or identifies areas that reduce our ability to drive quality and lower total cost of care.
• Acts as the primary operational and business liaison between the ProHealth market and Regional/National Optum teams for the purpose of maximizing standardization, the benefits and performance of value-based care products and platforms.
• Maintains a robust understanding of Optum Health's (national) and external/localized value-based care solutions that can improve quality, enhance experience, and reduce medical costs.
• Supports the assessment of external vendors or national Optum Health solutions as it relates to quality, medical management, and affordability.
• Implements/oversees programs to enhance quality of patient care & outcomes.
• Analyzes clinical data to identify areas of opportunity to improve quality.
• Creates visual tools to educate and engage the clinical workforce in these efforts.
• Establishes and monitors key performance indicators related to patient care quality.
• Fosters a culture of clinical quality including educating and engaging the clinical workforce in quality efforts.
• Designs, implements, and monitors medical care practices so that timely access, service, and high-quality medical care are provided to the organization's patients.
• Works collaboratively with all third-party payers to ensure an effective interface with ProHealth and their medical management and quality improvement programs, including any pertinent financial quality incentives, with optimization of the financial yield to the organization for these programs.
• Develops and implements guidelines, protocols and care pathways pertaining to medical care for patients at the organization, particularly for those clinical conditions for which there are not already established guidelines provided by our major third-party payers.
• Ensures compliance with regulatory agencies such as DPH, etc.
• Develops and maintains procedures necessary to meet regulatory requirements.
• Communicates with internal & external stakeholders about the organization's efforts and advancements in quality.
• Develops and delivers presentations to a variety of audiences, including senior executive.
• Works in a highly matrixed environment and fosters cross-functional collaboration, best practice sharing and creates an aligned vision of value-based care initiative goals.
• Fosters a culture of continuous improvement and accountability.
• Participates in market-based strategic planning, joint operating committees, & national clinical committees.
• Oversee any utilization management functions, case management functions, and risk adjustment.
• Performs other duties as assigned.

Benefits

• Comprehensive benefits package.
• Incentive and recognition programs.
• Equity stock purchase.
• 401k contribution.

What This Job Offers

• Job Type: Full-time
• Career Level: Senior
• Industry: Professional, Scientific, and Technical Services
• Education Level: Bachelor's degree