Clinical Practice Coach

4 weeks ago

Rancho Cucamonga CA United States Inland Empire Health Plan Full time
What you can expect

Find joy in serving others with IEHP We welcome you to join us in “healing and inspiring the human spirit” and to pivot from a “job” opportunity to an authentic experience

The Clinical Practice Coach & Oversight, Enhance Care Management (ECM), RN will be under the work direction of the Practice Coach Manager for ECM. ECM is a benefit program that implements interventions at the practice level to improve clinical performance, targeted outcomes to improve patient care, and implements strategies to achieve targeted transformation outcomes.

The Clinical Practice Coach & Oversight, ECM, RN will be responsible for maintaining and monitoring transformation and strategic workflows, identifying any challenges and barriers and working with practices to facilitate redesign efforts. This position will help provide clinical guidance to the care teams, follow up on population health management and measurement base care and work towards improved processes, clinical outcomes, and value-based care. The Clinical Practice Coach & Oversight, ECM, RN is responsible for staying up do date with ECM Model of Care, DHCS, NCQA and HEDIS measures.

The Clinical Practice Coach & Oversight, ECM, RN will work in partnership with Practice Coaches to help develop any clinical workflows and training materials. Help educate ECM care teams of most appropriate decision in managing patients’ conditions and navigating the complexities of a multidisciplinary care team. The Clinical Practice Coach & Oversight, ECM, RN may also be deployed to other partner sites based on current strategic initiatives.

Major Functions (Duties and Responsibilities)

1. Assist ECM Providers and Care Teams with interpreting IEHP ECM Model of Care and DHCS regulatory requirements.
2. Provide on-site and remote clinical guidance to providers, clinicians and care teams; help improve efficiency and quality by using workflow design, data tracking, reporting, and clinical data measures and transformation, with focus in:
a. Patient and family centered care design
b. Continuous, data driven quality improvement
c. Sustainable business operations
d. Pay for performance and value-based payment
e. Preventative services
f. Effective utilization of the IEHP Provider portal for referrals and authorization request
g. HEDIS performance metrics
3. Provide clinical assistance, clinical trainings, and practice guidance to external partners: i.e., face to face meetings, bi-monthly coaching sessions, and webinars.
4. Work collaboratively with Practice Coaches, ECM Team Members, ECM Managers and Leadership to develop future material, share best practices, and work on strategies achieve best outcomes.
5. Responsible for providing delegation oversite and conducting chart reviews.
6. Monitor clinical documentation e.g., disenrollment, overturns for approval, approvals, and other clinical interventions for appropriateness.
7. Provide clinical training to address chart audit findings to ECM Providers and Care Teams.
8. Monitor and oversight ECM Care Teams and Providers to ensure adherence of clinical interventions, pathways, algorithms, and tool kits for chronic care conditions
9. Responsible for understanding current HEDIS and MCAS technical specifications with the ability to interpreting measures to ECM providers and care teams and developing strategies on capturing value-based metrics and quality measures.
10. Establish and maintain a supportive role with the ECM staff, network partner management, coaching teams, assigned clinicians, care teams and their associated practices.
11. Collaborate with Provider Service Representatives (PSR) to identify providers that will benefit from additional clinical training and support, and to coordinate in partnership to deliver the identified training need.
12. Provide feedback for opportunities to Quality Management for facility and medical record reviews, and Provider Services for any appropriate cases and concerns for further provider discussions.
13. Apply LEAN principles and concepts, (i.e., build quality, eliminate waste, optimize, increase productivity, and reduce costs) to provider performance outcomes to assist with improvement activities of the organization.
14. Collaborate actively with Quality Management, Special Initiatives, ECM, and Provider Service Representatives Teams to review performance metrics and/or concerns of the external partners.

Commitment to Quality: The IEHP Team is committed to incorporate IEHP’s Quality Program goals including, but not limited to, HEDIS, CAHPS, and NCQA Accreditation.

Perks

IEHP is not only committed to healing and inspiring the human spirit of our Members; we also aim to match our Team Members with the same energy by providing prime benefits and more.

CalPERS retirement
457(b) option with a contribution match
Generous paid time off- vacation, holidays, sick
State of the art fitness center on-site
Medical Insurance with Dental and Vision
Paid life insurance for employees with additional options
Short-term, and long-term disability options
Pet care insurance
Flexible Spending Account – Health Care/Childcare
Wellness programs that promote a healthy work-life balance
Career advancement opportunities and professional development
Competitive salary with annual merit increase
Team bonus opportunities

Education & Experience

Five (5) years of experience in a health-related area
Operations experience in a physician’s office or hospital
Experience with quality and process improvement
Experience with Electronic Medical Records
Bachelor’s degree in Nursing or a related field from an accredited institution required
Possession of an active, unrestricted, and unencumbered Registered Nurse (RN) license issued by the California Board of Registered Nursing required

Key Qualifications

Strong clinical knowledge, project management, communication and relationship management skills that can be used in a fluid program environment
Able to implement PDSA or like quality improvement methodologies using a data driven method
Highly organized and able to handle multiple priorities
Excellent oral and written communication skills
Excellent interpersonal skills, diplomacy, coaching and change management skills
Good Microsoft application skills (Word, Excel, and PowerPoint)

Start your journey towards a thriving future with IEHP and apply TODAY

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