Practice Transformation Associate

CVS Health•Field-Florida, FL

2d•$60,300 - $132,600•Hybrid

About The Position

We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time. This is a Field based role requiring 50% travel with in the state of Florida. The Practice Transformation Associate builds positive relationships between Aetna Better Health (ABH) and its high-volume providers to facilitate high quality care for members. The Liaison achieves this goal through analyzing and sharing provider performance metrics related to quality, clinical outcomes, coding, and utilization used to support ABH programs. They will be a liaison between ABH providers and in select markets will be a part of a model consisting of an internal, cross-functional team of clinical, analytics, provider relations and medical personnel. The PTA will work both internally and externally with some travel time in the field to assigned provider offices.

Requirements

Bachelor’s degree in healthcare or related discipline or three years of relevant work experience
Three years’ experience in practice management or an administrative leadership role in primary care setting
Three years’ experience in managed care with a focus on HEDIS and Quality with experience facilitating and leading meetings with provider offices and proven track record of improving performance with your market
Knowledge of HEDIS and Pay for Performance metrics, ICD-10 coding, Medicaid risk adjustment methodology, and common billing and common billing practices
Demonstrated understanding of Medicaid industry standards and NCQA requirements
Proficient in Microsoft Office tools
Strong analytical skills regarding HEDIS metrics and quality reporting
Articulate and professional communication skills, both verbally and written
An ability to travel (up to three days a week) across the assigned territory for in-person provider support
Valid driver’s license in good standing and access to a reliable vehicle required with insurance.
Demonstrated experience in leading significant cross-functional work that includes business owners, executive leadership, and peers across the organization

Nice To Haves

RHI, RHIT, CRC, or CPC certified Coder or auditor (CMAS)
RN or LPN or LISW
Three years’ experience in managed care with a focus on HEDIS and Quality
Ability to manage relationships with an emphasis on internal and external mid-level relationships
Ability to work across all levels of the organization, including working with executive audiences, vendors, and government as a customer
Demonstrated ability to project manage and implement strategies to improve performance

Responsibilities

Builds positive relationships between Aetna Better Health (ABH) and its high-volume providers to facilitate high quality care for members.
Analyzes and shares provider performance metrics related to quality, clinical outcomes, coding, and utilization used to support ABH programs.
Acts as a liaison between ABH providers and, in select markets, will be part of a model consisting of an internal, cross-functional team of clinical, analytics, provider relations and medical personnel.
Works both internally and externally with some travel time in the field to assigned provider offices.