Under the general supervision of the COO, the primary responsibility of the Population Health Manager serves as the designated clinical leader for Camino's Population Health Program. A key role of this position is to build strong and collaborative relationships with physicians, advanced care practitioners, care team members, and payers. The Population Health Manager is responsible for overseeing clinical quality performance and population health outcomes. The Population Health Manager will champion population health strategies to support Camino's annual goals and objectives in the value-based healthcare environment.

The Population Health Manager is a part of the Management Team

Essential Functions: 

Population Health

• Responsible for driving clinical practice changes to support population health programs including the transition into full professional risk and advanced payment models that reward population health metrics
• Promotes a culture of quality and aids in the development, implementation, and standardization of activities related to improving clinical performance measures and quality programs.
• Assists the Quality Improvement Director in coordinating the adherence to requirements of the National Council on Quality Assurance’s (NCQA) and Patient Centered Medical Home (PCMH) recognition program.
• Supports the development, implementation, and ongoing compliance requirements of the Federal Tort Claims Act (FTCA) medical malpractice coverage program.
• Participates in and assist with the preparation for all clinical audits and surveys. 
• Assists with preparing reports for the Camino Board of Directors and presents relevant information as requested.
• Serve as lead population health liaison to external health care partners, external providers, and applicable regulatory and credentialing organizations.
• Helps lead the transition into a full professional risk and advanced payment environment that rewards exceptional clinical care, service, and cost effectiveness.
• Focuses on models of care that improve population health, enhance reimbursement through value-based contracts, and shared risk opportunities.
• Leads physicians and advanced care practitioners through the change process from providing care for individuals to providing care for populations, to include assisting with the development and achievement of population health and clinical integration metrics.
• Work collaborative with QI department and Operations to support projects, Grants, and all things Population health.
• Participates in committee activities as requested.

Leadership

• Collaborates with other leaders to improve the operations of Camino including strategic planning, patient satisfaction, quality assurance, and other operational improvements.
• Participates as an active member of the Management Team and contributes to the overall success of the health center.
• Researches, writes and updates policies and procedures as requested by the Executive Team.
• Prepares reports for the Camino Board of Directors and presents relevant information. Participates and leads committee activities as requested.
• Keeps staff informed of organization activities and promotes Camino Health Center’s mission, vision, values and goals.
• Conducts team and department meetings to promote good communication, assess and resolve barriers to achieving quality and risk management goals and foster good teamwork.
• Responds to the Executive Team’s request for special projects and represents Camino Health Center as needed. 
• Keeps abreast of current trends and innovative programs related to quality improvement and risk management aspects of health care delivery.

Public and Private Grant Funding

• Leads the development of public grant-funded programs for the health center.
• Researches and recommends public funding sources to leadership.
• Writes grants and submits approved applications/proposals for funding.
• Assists Development Director in identifying and applying for private grants.
• Works with Development Director to establish goals to ensure the health center maintains necessary grant funding each year.
• Collaborates with the health center’s clinical and management team in the design and implementation of grant-funded programs.
• Oversees and leads the HRSA Service Area Competition (SAC), New Access Point (NAP) and Supplemental grant applications.
• Ensures completion of the HRSA Change in Scopes (CIS) program.
• Prepares for and facilitates the HRSA Operational Site Visits (OSV).
• Maintains the health center’s DUNs, SAM, and Grants.gov portfolios.
• Prepares and responds to requests stemming from external program and fiscal audits.

Reporting & Analytics

• The PH Manager will coordinate and develop the infrastructure and strategies to facilitate the implementation of Performance Improvement and achievement of CHC goals, including integration of EHR workflows and performance improvement strategies, projects, and activities.
• Ensures completion of OSHPD/HCAI, Budget Period Progress Reports (BPR), UDS and all other HRSA required supplemental reports.
• Ensures the proper preparation and coordination efforts to achieve regulatory compliance with HRSA and other regulatory agencies for Quality Indicators.
• Responsible for data integrity of internal and external data reporting.
• Provides reports for different payor designations, i.e., Cal Optima, Optum, UDS and HEDIS.
• Generates patient list and monitors Patient Experience outcomes from Press Ganey.
• Responsible for monitoring ongoing progress towards meeting various programmatic measures including but not limited to FQHC Clinical Performance Measures and Healthcare Effectiveness Data and Information Set (HEDIS).
• Develops, maintains, and analyzes reports addressing health center’s operational and demographic trends and presents findings.
• Builds monthly and ad hoc reports to review trends for executive team and department leaders.

Administrative and Program Support

• Collaborates with the leadership team by assisting with special projects as identified.
• Manages the WeCare email account.
• Collaborates with the Quality Improvement Director on the submissions of PCMH and FTCA applications.
• Collaborates to support implementation/modification of various information system platforms (Allscripts, FollowMyHealth, PatientLink, i2i Tracks, Press Ganey).
• Participates in the patient complaint/grievance investigation process.
• Represents the health center at community meetings related to programs and grants.
• Conducts presentations in the community related to the health center’s programs and grants.
• Participates in and coordinates periodic community needs assessments.
• Participates in Allscripts FQHC Roundtable to discuss best practices with the health center’s electronic health record
• Participates in the health center’s external and internal committees as assigned.
• Incorporates initiatives that will increase patient engagement.

Minimum Position Qualifications: List the minimum qualifications required for this position.

• Education: Bachelor’s Degree in Nursing or Completed an accredited LVN program

• Experience / Training: Two years of working in either Quality, Health Planning, Case Management, or Population Health
  • Knowledge of organization wide QI projects; data analytics and reporting; federal grant writing and reporting, highly desired.
  • Experience working with Electronic Health Records
  • Experience with federal grant writing and reporting such as HRSA Service Area Competition (SAC)
• License/Certification:
  • Current LVN/RN License
  • Current BLS Certification

Preferred Position Qualifications: List the preferred qualifications required for this position.

• Education: Master’s Degree in Nursing, Public Health, Public Administration, or related health field
• Experience / Training: Five to ten years of working in either Quality, Health Planning, Case Management, or Population Health;
  • Experience with CalAim or Enhanced Care Management
  • Experience working with disadvantaged populations and knowledge of health disparities highly desired. Bilingual (English/Spanish). Experience with the following platforms Allscripts, FollowMyHealth, PatientLink, i2i Track, and Press Ganey.
• License / Certification: Lean Six Sigma Green Belt Certification, JEDI Certification