Transformation Specialist

This is a hybrid role requiring 3 days a week in office or at provider sites. This role supports the Southeastern PA market (SEPA) and will require local travel.

This job is directly responsible for outcomes of providers contracted in the Organization's gain/risk share arrangements and is a highly skilled expert in practice transformation to achieve the specific targets set in the individual gain/risk share contracts and is strategically focused on those data gaps that will result in the greatest ROI for the Organization.

• Directly responsible for supporting providers contracted in the Organization's gain/risk share programs, with a goal of maximizing quality and ROI for the Organization. This includes analyzing performance reports and data to inform decision-making, process, and program implementation, as well as the development of process interventions based on practice-level data, trends and identified opportunities.
• Advising primary care practices, physicians, nurses and other clinical staff to assist them on their conversion to value-based care; Dissemination and interpretation of quality and efficiency reports; When relevant, dissemination and support of gap closures for STARS and improved coding for government populations.
• Identification of process improvement gaps in workflow and development of individualized plans to remedy. Providing educational and training sessions. Creation and maintenance of relationships with specialists and/or hospital resources for providers employed in multi-specialty groups or health systems.
• For value-based contracts addressing government markets, directly responsible for the quality improvement and cost savings outcomes as a result of workflow transformation, superior coding accuracy, and Medicare STARS gap closure to providers based upon each individual gain/risk share contract parameters.
• Function as the Organization's key contact on gain/risk share multi-disciplinary team. This includes presentation of program results to both internal and external audiences, including practice and entity meetings with the value-based reimbursement multi-disciplinary team.
• Participates in the development and presentation of instructional materials for internal and external audiences.
• Provides feedback to and collaborates with the analytics team to ensure reports are accurate, and provide meaningful, actionable data. Provide assistance to providers in the use of predictive analytic tools, user interfaces, population health management tools and other data-based platforms endorsed by the Organization.
• Independently and autonomously manage gain/risk share contract caseloads, projects, meetings, deliverables, resources etc. for individualized strategic plans to ensure significant cost savings for provider contract holders using innovative continuous improvement methodologies.

• Bachelor's Degree in Business, Finance or Healthcare related field and an RN license or Bachelor's Degree in Nursing.
• Minimum 5 years in practice transformation including population health, ambulatory care setting quality and efficiency metrics, accountable care organization development and support, patient-centered medical home, and electronic health records.
• Experience may be from either health plan or provider employers.
• Familiarity with electronic health records and population health IT solutions.
• Demonstrated experience working with healthcare data and analytics.
• Experience in Lean, Six Sigma, risk management, contract management, finance management.

• Must be able to effectively resolve issues and problems across all areas of the corporation, by understanding corporate strategies, policy and scope of authority.
• Aptitude for a high-visibility position demanding integrity, uncompromising professionalism, diplomacy and conflict management.
• Demonstrates a deep understanding of primary care practice operations and workflow across the continuum of variability in primary care and experience in managing provider and administrative leadership relationships.
• Superior written and verbal communication skills and listening skills.
• Ability to adapt engagement strategies to meet market needs.

• Registered Nurse.

0% - 25%

Office-based. Teaches/trains others regularly. Occasionally travel from the office to various work sites or from site-to-site. Rarely works primarily out-of-the office selling products/services (sales employees). Never physical work site required. Lifting: up to 10 pounds. Constantly. Lifting: 10 to 25 pounds. Occasionally. Lifting: 25 to 50 pounds. Rarely.