Population Health Strategist

2 weeks ago

Bend, United States PacificSource Health Plans Full time

Summary

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.


Essential 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.


Supporting Responsibilities:

  • 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.


Work Experience: Minimum of 5 years of experience in the healthcare industry. Health care clinic experience required. Operational leadership or clinic manager preferred and/or other Population Health Program implementation experience.


Education, Certificates, Licenses: Bachelor degree in healthcare administration or similar field is required or equivalent work experience. Master’s degree and/or Clinical license preferred.


  • Knowledge: 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. 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. Must have strong analytical, influencing, and problem-solving skills. 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.


Competencies:

  • Building Trust
  • Building Customer Loyalty
  • Facilitating Change
  • Driving for Results
  • Building Strategic Work Relationships
  • Leveraging Diversity
  • Decision Making
  • Building a Successful Team
  • Aligning Performance for Success
  • Continuous Improvement


Environment: Work inside in a general office setting with ergonomically configured equipment. Travel is required approximately 25-50% of the time.

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