Practice Transformation Strategist
7 days ago
Candidates for this position must reside on the Central Coast (Ventura, Santa Barbara, San Luis Obispo, Monterey and Santa Cruz Counties) or be willing to relocate to the area upon hire. As a community-facing role, a local presence is essential to effectively engage with and serve our community. Please note that relocation assistance may be available.
Job Summary
The Quality Department is committed to improving health outcomes by enhancing the quality, safety, and equity of care provided to members through collaborative partnerships with providers and community organizations.
This role reports to CenCal Health's Population Health Manager and focuses on ensuring compliance with regulatory requirements for National Committee for Quality Assurance (NCQA), the Department of Healthcare Services (DHCS) and Centers for Medicare & Medicaid Services (CMS) for Managed Care Organizations. Key responsibilities include:
- Working with cross-functional teams and the CenCal Health Provider Network to implement transformational changes that improve patient outcomes and optimize care delivery.
- Acting as a subject matter expert, offering strategic advice and support to quality and population health programs and stakeholders.
- Performing other duties as assigned.
Duties & Responsibilities
1. Collaboration and Transformation Initiatives:
Work closely with cross-functional teams and the CenCal Health Provider Network to drive transformational changes focused on improving patient outcomes and maximizing the quality of care, with responsibilities including, but not limited to:
- Collaborating with CenCal Health's Primary Care Practitioner network, Director of Quality, Population Health Manager, Supervisors of Quality Measurement, Health Promotion, Population Health, and other department leaders to ensure the integration of operational systems across CenCal Health.
- Leading clinical practice transformation initiatives aimed at enhancing healthcare delivery, including serving as a liaison to Primary Care Practitioners to foster in-person collaboration and practice transformation.
- Partnering with relevant business owners to develop department-specific work plans and corrective action plans to address any gaps in meeting regulatory, accreditation, or quality/population health management requirements.
- Continuously engaging with internal and external stakeholders to support the development and implementation of population health programs, quality improvement initiatives, and health equity interventions.
- Collaborating with the provider network to promote the adoption of evidence-based practices, offering education and resources to help integrate best practices, transform clinical workflows, implement quality improvement initiatives, and enhance patient-centered care.
- Planning, deploying, and executing strategies and processes to monitor and maintain NCQA compliance with operational standards relevant to the Quality Department's oversight.
- Leading quality improvement and population health initiatives designed to improve patient outcomes and reduce healthcare disparities by designing, implementing, and evaluating initiatives that enhance clinical outcomes.
- Supporting programs aligned with California Advancing and Innovating Medi-Cal (CalAIM) requirements to help advance CenCal Health's vision of eliminating health inequities.
- Preparing and filing reports or submitting required information to regulatory and accrediting agencies.
- Escalating potential compliance issues identified during accreditation readiness activities, policy oversight, new vendor implementations, and other related initiatives to the Population Health Manager/Quality Director.
- Collaborating with internal teams and the Information Technology Division to develop reports and implement solutions that support practice transformation goals.
- Supporting programs aligned with Medicare Star Ratings Program requirements.
Provide subject matter expertise and strategic advice to the quality and population health programs and stakeholders, with responsibilities including, but not limited to:
- Assisting in aligning regulatory and accreditation strategies with organizational goals, and supporting the execution of strategic plans to enhance CenCal Health's standing.
- Serving as a subject matter expert on practice transformation methodologies, quality improvement frameworks, and value-based care models.
- Proactively guiding process development, execution, and continuous performance surveillance of regulatory and accreditation requirements.
- Recommending strategies to optimize CenCal Health's ability to address social determinants of health, health disparities, and quality improvement processes.
- Developing and delivering training programs for interdepartmental staff and the provider network.
- Contributing expertise to multidisciplinary teams focused on quality improvement, care coordination, and population health management initiatives.
- Attending stakeholder meetings as requested.
Motivating Others to Achieve Extraordinary Results
Inspire and unite others to turn challenges into successes by embracing 'The Five Practices of Exemplary Leadership' from The Leadership Challenge:
1. Model the Way:
- Clarify values by finding your voice and affirming shared values.
- Set the example by aligning actions with shared values.
- Envision the future by imagining exciting and inspiring possibilities.
- Enlist others in a common vision by appealing to shared aspirations.
- Search for opportunities by taking initiative and exploring innovative ways to improve.
- Experiment and take risks by generating small wins and learning from experience.
- Foster collaboration by building trust and facilitating relationships.
- Strengthen others by enhancing self-determination and developing competence.
- Recognize contributions by showing appreciation for individual excellence.
- Celebrate values and victories by creating a spirit of community.
Required
- In-depth knowledge of managed care operations, regulatory compliance, and processes for measuring and continuously monitoring operational performance.
- Comprehensive understanding of NCQA accreditation standards, with the ability to serve as a technical resource for others.
- Strong expertise in using data for total quality management to drive process excellence (e.g., statistical process control).
- Proven ability to thrive independently in a fast-paced environment, managing complex projects with multiple priorities.
- Exceptional time management skills, with the ability to effectively prioritize responsibilities to meet stakeholder needs and project deadlines.
- Understanding of population health program theory, development, and practices.
- Expertise in quality improvement theory, strategies, and methods for achieving rapid-cycle improvements.
- Willingness to travel regularly to provider offices for in-person practice transformation visits, along with occasional virtual meetings.
- Capability to provide practice transformation support.
- Ability to inspire and motivate high-performing teams while contributing to a collaborative team dynamic.
- Creative problem-solving skills in systems development and improvement, while managing multiple priorities.
- Strong ability to establish and maintain positive professional relationships both within CenCal Health and with external stakeholders.
- Skill in receiving and providing constructive feedback, including feedback to supervisors and peers.
- Analytical skills to evaluate data, establish facts, and draw valid conclusions.
- Capacity to take responsibility and exercise sound judgment in decision-making within the scope of the role's authority.
- Self-motivated to pursue knowledge and enhance personal and professional growth.
- Strong verbal and written communication skills.
- Proficiency in Microsoft Word, Excel, Outlook, and PowerPoint.
- Knowledge of State and Local social service agencies and community-based organizations.
- Familiarity with NCQA HEDIS Technical Specifications.
- Understanding of the NCQA Patient-Centered Medical Home Recognition program.
- Bilingual in Spanish.
Required:
- Associate's degree in a relevant field.
- Five (5) years of experience in a leadership role, or a combination of an advanced degree (Bachelor's/Master's) and two (2) years of leadership experience.
- Five (5) years of experience in Medicare or Medi-Cal managed care, or a combination of both.
- Five (5) years of experience managing audit relations with managed care regulatory or accrediting bodies (e.g., NCQA, CMS, DHCS, EQRO).
- Three (3) years of experience in a population health or quality improvement setting.
- Proficiency in creating and preparing reports and presentations.
- Experience working in a clinical setting.
- Active, unrestricted Registered Nurse license.
- Formal certification in relevant professional areas (e.g., CPHQ, HCC) is preferred.
- Experience with HEDIS Compliance Audit standards.
- Experience working collaboratively with community-based organizations.
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