Population Health Strategist
About The Position
Responsible for successful execution, coordination and support of PacificSource’s clinical/quality improvement initiatives, across all lines of business. Key areas of focus include oversight and management of provider clinical engagement and performance on patient populations. This is done through collaborating with targeted provider groups to guide and develop practice specific strategies designed to optimize clinical quality outcomes, risk assessment performance, and clinical outcomes via care management and cost containment. Work directly with internal PacificSource departments to build/strengthen relationships with strategic provider partners; ensure effective education, analyze and generate specific clinical reports and proactively identify clinical improvement opportunities that support PacificSource’s strategic goals. Assist with the development and execution of region specific strategies and practice coaching.
Requirements
- Minimum of 5 years of experience in the healthcare industry required.
- Bachelor degree in healthcare administration or similar field is required or equivalent work experience.
- Knowledge/experience with quality improvement initiatives in the clinic setting including clinical quality outcomes and patient experience.
- Knowledge of national and state quality measures such as CMS Stars, NCQA, HEDIS, CAHPS/HOS required.
- Strong computer skills using Word, Excel, and PowerPoint.
- Understanding of quality initiatives, evidence based medicine and care coordination required.
- Demonstrated ability to effectively communicate with all levels of a staff and management including executive leaders.
- Proven ability to learn new healthcare information systems and work with multiple business systems.
- Must be self-motivated, organized, and detailed oriented.
Nice To Haves
- Health care clinic experience preferred.
- Operational leadership or clinic manager preferred and/or other Population Health Program implementation experience preferred.
- Master’s degree and/or Clinical license preferred.
- Experience with medical billing, claims processing systems, data analytics, and health care information strongly preferred.
- Knowledge and experience implementing continuous improvement efforts or LEAN concepts strongly preferred.
Responsibilities
- Assist with the development and execution of enterprise wide provider campaigns focused on improving clinically oriented improvement and outcomes. (HEDIS, CAHPS/HOS scores and other identified quality improvement measures).
- Provide ongoing training, coaching and high-touch support to network providers and clinic staff toward the development and implementation of improvement initiatives (clinical quality, member experience, clinical workflows, and documentation/coding practices) within their own practices.
- Establish credible, consultative relationships with network physicians and clinic staff as a subject matter expert on clinical quality improvement measures and risk assessment including the technical reporting and documentation requirements NCQA (HEDIS and CAHPS), risk adjustment.
- Collaborate with multiple departments (Risk Assessment, Care Management, Utilization Management, Pharmacy, and Medical Directors) to develop and deploy aligned quality performance programs to drive member care outcomes and improved provider satisfaction.
- Maintain a detailed understanding of all shared data elements (clinical outcomes, ICD-10 coding, and documentation) and the systems necessary to support actionable interventions.
- Support internal initiatives to improve the collection and reporting of supplemental HEDIS data as related to provider populations.
- Evaluate quality programs, initiatives and interventions utilizing multiple data sources to determine the effectiveness of activities and make recommendations to improve outcomes for CMS Stars, NCQA, QIM (HEDIS, CAHPS).
- Lead internal/external cross functional teams with regional focus to develop and deploy annual improvement plans with performance metrics, monitor risk, deploy mitigation strategies and elevate to joint operating committees as needed.
- Support all clinical and quality dyads with provider payer partnerships to optimize engagement, drive performance and improve provider/member experience in service to growth strategy.
- Represent Quality Improvement internal committees and workgroups.
- Meet department and company performance and attendance expectations.
- Follow the PacificSource privacy policy and HIPAA laws and regulations concerning confidentiality and security of protected health information.
- Perform other duties as assigned.
Benefits
- Flexible telecommute policy
- medical, vision, and dental insurance
- incentive program
- paid time off and holidays
- 401(k) plan
- volunteer opportunities
- tuition reimbursement and training
- life insurance
- flexible spending account
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
Associate degree
