Healthcare Transformation Manager

4 weeks ago

San Jose, California, United States Santa Clara County Health Plan Full time
Job Summary

We are seeking a highly skilled and experienced professional to join our team as a Manager, Provider Practice Transformation. This role will be responsible for leading the Provider Network Operations team in quality improvement initiatives and practice transformation activities within our provider network.

Key Responsibilities
  • Develop and implement strategies to improve network performance, including communication, outreach, implementation, training, education, service, measurement, and reporting of quality improvement and practice transformation initiatives.
  • Establish and maintain trusting relationships with providers, staff, and leadership of contracted health plans, physicians, hospitals, ancillary providers, and IPAs to drive innovation and continuous quality improvement.
  • Collaborate with SCFHP's Quality Improvement, Health Equity, and Risk Adjustment teams to further PPP and practice transformation initiatives.
  • Develop and conduct internal training across departments to ensure appropriate knowledge and tools exist throughout the organization for servicing providers and understanding handoffs between departments.
  • Effectively manage SCFHP's practice transformation consultants to ensure deliverables are met.
  • Represent the department at SCFHP committee meetings and act as a subject matter expert for cross-functional activities.
  • Hire, manage, and develop the PPP team to develop effective communication strategies, including timely, documented efforts related to education of new and existing providers, questions from providers, interventions addressing concerns regarding quality of service impacting health plan members, and action plans that pertain to specific initiatives with the SCFHP provider network.
  • Represent SCFHP in the provider community for quality of care, HEDIS, and PPP, including but not limited to, representing the department and SCFHP at internal and external meetings and events.
  • Manage the planning, execution, and evaluation of QIHEP initiatives, HEDIS, and practice transformation provider projects from initiation/pilot phase through project closure to improve quality performance, SCFHP's HEDIS scores, and other quality metrics.
Requirements
  • Bachelor's Degree in Business, Healthcare Administration, or a related field, or equivalent experience, training, or coursework.
  • Minimum six years of experience in a healthcare, clinical, or managed care setting, provider organization, or health policy organization requiring routine interaction with internal and external stakeholders and program management responsibilities.
  • Demonstrated achievement and progressive responsibilities in the area of provider network management.
  • Minimum three years direct supervisory/management experience.
  • Ability to establish and maintain effective internal and external working relationships to organize and lead cross-functional teams.
  • Experience developing training materials.
  • Ability to create and deliver effective presentations to diverse groups.
  • Ability to consistently meet compliance accuracy and timeline requirements by achieving regulatory standards.
  • Ability to organize, plan, direct, and manage medium to large-scale, complex, cross-functional, multi-departmental projects and/or programs to completion with minimal supervision.
  • Ability to track, gather, and analyze large data sets and organize/write reports.
  • Strong project management experience.
  • Knowledge and experience with program evaluation.
  • Excellent communication skills, including the ability to express oneself clearly and concisely when providing service to SCFHP internal departments, providers, and outside entities over the telephone, in person, or in writing.
  • Strong writing skills and demonstrated proficiency in developing content related to provider manuals, training materials, and web content.
  • Strong understanding of NCQA, HEDIS, and government requirements.
  • Proficient in adapting to changing situations and efficiently alternating focus between tasks to support department operations as dictated by business needs.
  • Working knowledge and the ability to efficiently operate all applicable computer software, including applications such as Outlook, Word, and Excel.
  • Ability to assume responsibility and exercise good judgment when making decisions within the scope of the position.
  • Ability to maintain confidentiality.
  • Ability to comply with all SCFHP policies and procedures.
  • Ability to perform the job safely with respect to others, to property, and to individual safety.
  • Maintenance of a valid California driver's license and acceptable driving record, in order to drive to and from off-site meetings or events, or the ability to use other means of transportation to attend off-site meetings or events.
Working Conditions

Generally, duties are primarily performed in an office environment while sitting or standing at a desk. Incumbents are subject to frequent contact with and interruptions by co-workers, supervisors, and plan members or providers in person, by telephone, and by work-related electronic communications.

Physical Requirements

Incumbents must be able to perform the essential functions of this job, with or without reasonable accommodation:

  • Mobility Requirements: regular bending at the waist, and reaching overhead, above the shoulders, and horizontally, to retrieve and store files and supplies and sit or stand for extended periods of time.
  • Lifting Requirements: regularly lift and carry files, notebooks, and office supplies that may weigh up to 15 pounds.
  • Visual Requirements: ability to read information in printed materials and on a computer screen; perform close-up work; clarity of vision is required at 20 inches or less.
  • Dexterity Requirements: regular use of hands, wrists, and finger movements; ability to perform repetitive motion (keyboard); writing (note-taking); ability to operate a computer keyboard and other office equipment.
  • Hearing/Talking Requirements: ability to hear normal speech, hear and talk to exchange information in person and on telephone.
  • Reasoning Requirements: ability to think and work effectively under pressure; ability to effectively serve customers; decision making, maintain a concentrated level of attention to information communicated in person and by telephone throughout a typical workday; attention to detail.
Environmental Conditions

General office conditions. May be exposed to moderate noise levels.

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