Senior Practice Facilitator

Cinqcare • Carbondale, IL

1d • Hybrid

About The Position

Grace at Home is an innovative health and care company on a mission to eliminate barriers and to improve care in high-need, urban and rural communities. Grace at Home’s purpose is to every day improve the health and well-being of those who need care the most – in their homes and communities. Overview The Practice Facilitator (RN) is a registered nurse who supports primary care practices participating in value-based payment programs by guiding, coaching, and enabling practice transformation efforts. This role partners closely with practice champions and care teams to improve clinical quality, patient-centered care delivery, operational workflows, and total cost of care for defined populations. The Practice Facilitator focuses on implementing evidence-based quality improvement strategies, supporting population health initiatives, and integrating value-based care best practices within clinical workflows. This is a hybrid role that requires frequent travel to primary care practices and community sites to provide hands-on, on-site support and collaboration. Maintaining close follow ups on regularly scheduled virtual meetings with practice representatives will be necessary to build relationships to aide in successful initiative implementation. Core performance outcomes are directly related to the ability to fully execute interventions or workflows within the practice, in 5 key areas: Membership alignment (ex. Voluntary Alignment for ACO Reach) Managing the highest risk membership Transition of Care/readmission prevention Quality Gap Closure Documentation Accuracy

Requirements

• Active Registered Nurse (RN) license in good standing is preferred. Equivalent education or experience considered.
• Bachelor of Science in Nursing (BSN) preferred; associate degree in nursing with relevant experience considered.
• REQUIRED: Experience working in a medical office setting, preferably primary care.
• Experience leading or supporting quality improvement initiatives, population health, or value-based care programs with interdisciplinary care teams.
• Training or experience in root cause analysis and development of quality improvement plans.
• Training or experience in EMR analytics/template development a plus
• Strong communication, coaching, and interpersonal skills to build trust and collaboration with clinical teams.
• Proactive professional who can take strategic direction and work with autonomy, creativity, and accountability, moving initiatives from concept to full execution.
• Excellent computer skills required particularly related to Microsoft applications including Word, Excel, PowerPoint, and Outlook.
• Willingness required to explore and learn new or unfamiliar applications and databases, and when prepared to teach practices and team members how to maximize technology.
• Knowledge of HEDIS/STAR measures, risk adjustment, and value-based care principles.
• Ability to analyze data and translate insights into actionable practice improvements
• Ability and willingness to travel frequently to practices and community sites.

Nice To Haves

• Knowledge of statistical software and other analytic software preferred
• Bilingual candidates strongly preferred.

Responsibilities

• Facilitate understanding and implementation of value-based payment programs, including ACOs, HEDIS/STAR measures, and risk adjustment initiatives.
• Present payer and performance scorecards to review benchmarks, identify gaps, and develop/execute improvement strategies.
• Develop and support practice-specific quality improvement plans using tailored data, tools, and resources.
• Obtain EMR access and collaborate with practice teams to close gaps in care and identify high-risk patients.
• Facilitate performance-based interventions in collaboration with internal subject matter experts for HEDIS/STAR and risk adjustment benchmarks.
• Analyze practice-level data and scorecards to identify trends, gaps, and opportunities for improvement.
• Provide education and coaching on clinical documentation, ICD-10/CPT coding accuracy, risk adjustment, and population health management activities (e.g., Transitions of Care, Annual Wellness Visits, high-risk case management).
• Guide care transformation initiatives using structured, evidence-based improvement methodologies such as Plan-Do-Study-Act (PDSA).
• Monitor key performance indicators (KPIs), medical loss ratio (MLR), and total cost of care (TCOC) to support improved outcomes.
• Effectively build and maintain trust-based relationships with practice leaders, clinicians, and care teams.
• Collaborate cross-functionally with internal departments and external stakeholders, interdisciplinary care team, Medical Director, Network Account Manager team, Quality leads, etc.
• Excellent verbal, written communication, and presentation skills; ability to clearly articulate and present concepts and models in an accessible manner to Grace At Home's team, investors, partners, and other stakeholders.
• Serve as a liaison between Grace at Home and healthcare practices to learn their needs, internalize their knowledge, and assist with solutions to achieve the business objectives of Grace At Home.
• Act as a clinical subject matter expert supporting initiatives such as Transitions of Care (TOC), pre-visit planning, Care Management, Annual Wellness Visits (AWV)/preventative care completion and Voluntary Alignment (or other contract-driven growth initiatives)
• Conduct direct patient outreach on behalf of supported practices as needed to support care gaps, quality initiatives, and value-based program requirements.
• Perform chart abstraction, review, and data validation activities to support HEDIS and STAR measures, ACO and MSSP reporting requirements, risk adjustment initiatives, and internal or external audits.
• Prepare and support submission of required clinical and quality documentation to payers or internal teams.
• Develop and maintain project plans, including milestones, timelines, and outcomes, to support practice transformation initiatives.
• Manage multiple concurrent practice engagements while prioritizing resources effectively.
• Conduct regular check-ins with practices to assess progress, reinforce goals, and identify emerging needs.
• Coordinate logistics for practice engagement meetings, including scheduling, agenda development, and follow-up.
• Maintain current knowledge of healthcare regulations, clinical quality standards, and value-based care models.
• Promote a culture of continuous improvement and adoption of best practices across supported practices.
• Document workflows, activities, and outcomes in designated systems and portals.
• Provide regular updates to leadership on progress, risks, and successes.
• Participate in training, meetings, and professional development activities as required.
• Travel frequently to healthcare practices to support on-site implementation and coaching.
• Perform other job-related duties as assigned.

Benefits

• Competitive Compensation: We offer competitive salaries to attract and retain the best talent.
• 401(k) with Employer Match: Plan for your future with our 401(k) plan and a generous 4% employer match.
• Comprehensive Medical Plan: We proudly offer a comprehensive medical option with an employer contribution.
• Dental & Vision Coverage: Maintain your oral and eye health with our employer-paid dental and vision plans via MetLife.
• Employer-Paid Insurance: Life, Short-Term Disability (STD), and Long-Term Disability (LTD) insurance are provided at no cost to you.
• Generous Paid Time Off: Enjoy ample time off for rest and rejuvenation with generous PTO, holidays, and wellness time.
• Continuing Medical Education (CME) Allowance for Providers: Stay at the forefront of your field with our CME allowance.
• Commuter Benefits: Save on your commute with our commuter benefits program.
• Mileage Reimbursement: Get reimbursed for work-related travel expenses.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level