Manager, Population Health- Must Reside in the State of Georgia!

CareSource•Georgia WFH, GA

13d•$83,000 - $132,800•Remote

About The Position

The Manager, Population Health is responsible for leading and managing the population health strategies that improve quality of care, access, and outcomes for CareSource members. This role oversees team-based care navigation efforts, supports quality improvement initiatives, leverages data to identify gaps and drive interventions, and collaborates with internal and external partners to advance member, provider, and community engagement.

Requirements

Bachelor of Science (B.S) in health-related field required
Three (3) years in a Managed Care Organization (MCO) or other healthcare related field required
Three (3) years of experience in quality or analytics required
Experience in data collection, analysis and trending of processes and outcomes
Proficient in Microsoft Office Suite to include, Word, Excel and PowerPoint
Knowledge of the principles of performance improvement, quality methodology, regulations and standards to meet health plan quality and accreditation requirements
Working knowledge of health plan policies and procedures
Ability to present pertinent data and recommendations clearly and concisely in a manner appropriate to end user audience(s)
Effective problem-solving skills with attention to detail
Ability to develop, prioritize and accomplish goals
Strong written and verbal communication skills
Strong interpersonal skills and high level of professionalism
Ability to work independently and within a team environment
Effective listening and critical thinking skills
Display a customer service, member-focused orientation
Current, unrestricted Registered Nurse (RN) licensure in state of practice preferred
Must reside in the State of Georgia

Nice To Haves

Master's degree in health services, public health, health care administration or other health care field preferred
Equivalent years of relevant work experience may be accepted in lieu of required education
additional two (2) years strongly preferred
Three (3) years of leadership/management experience preferred
Medicaid experience preferred
Experience in a high-growth business environment

Responsibilities

Work in collaboration with the Director of Population Health and Chief Medical Officer to implement and manage the population health management strategic plan for the market
Manage care navigation efforts of the team to ensure members are connected to appropriate resources, services, and supports that improve access to care, address identified barriers, and support quality outcomes.
Collaborate with the Enterprise Quality Improvement teams to support initiatives in the QI work plan and drive gap closure
Collaborate with other departments and business owners to improve quality of care and outcomes of CareSource women and children, including pregnant women, infants, children adolescents and teens through implementation of quality initiatives and interventions
In collaboration with Clinical Operations, ensures accreditation & quality requirements are met through review, audit and monitoring of quality improvement/performance improvement and accreditation activities
Collaborate with Network and Community Marketing teams to develop and implement wholistic and strategic community and provider engagement strategies
Collaborate with Health Equity and social determinants of health (SDOH) teams to support community-based partnerships that reduce SBOH barriers or access to care
Works with Enterprise and market analytics to leverage data to drive strategic community, provider and member engagement
Participates as requested in analysis, including root cause analyses, with support from identified business owners and departments; ensures data is presented and used effectively to address accreditation, clinical monitoring, and quality and performance improvement identified issues
In collaboration with Market Clinical Operations and Quality leadership, establishes and maintains standards and procedures for accreditation and quality reporting and documentation and communicates areas of strengths as well as opportunities for improvement to the Quality Management and Improvement Committee
Participates in national, state and local committees and focus groups that support various sup-populations and provides input on behalf of CareSource regarding any suggested quality initiatives, programs and/or revision(s)
Participates in internal workgroups/committees to improve quality measures, accreditation and clinical monitoring outcomes
Provides leadership, direction and development of staff to ensure the department goals are successfully achieved
Provides leadership and direction to staff to ensure the goals, standards, and compliance with CareSource, federal and state regulatory requirements are met
Responsible for coaching and development of staff, and support continuing education
Perform ongoing monitoring of staff performance, scheduling, productivity and quality to ensure optimal functioning and outcomes to meet business needs
Perform any other job related duties as requested.