Population Health Specialist

Description

California Annual Salary Range: $67,294 - $97,576 Annually

Job Summary

The Quality Department is committed to preventing disease, ensuring patient safety, and eliminating inequities by improving the quality of care members receive through partnerships with providers and community-based organizations. The Population Health Specialist will support designing, implementing, and maintaining population health management programs that address membership needs to advance health equity and reduce health disparities. This role supports health status and outcomes improvement through access to services, education, wellness support, and reinforcing the importance of preventive health.

The Population Health Specialist will be part of a collaborative team, working closely with the Director of Quality, Population Health Supervisor and/or Manager, Population Health Specialists, Health Promotion Educators, Quality Measurement Specialists/Analysts, Director of Member Services, Care Management staff, Pharmacy staff, Community Relations Representatives, Provider Services Representatives, and Information Technology (IT) staff. This collaborative approach ensures that our efforts are comprehensive and effective and that we are all working towards the same goal of improving population health.

Primary external contacts include representatives of communitybased organizations, Primary Care Providers (PCPs), and provider office staff.

Duties and Responsibilities

• Continuous collaboration with CenCal Health’s internal and external stakeholders to support and maintain compliance with the National Committee for Quality Assurance (NCQA) Accreditation Standards for Population Health Management, Quality, and Health Equity

• Support execution of CenCal Health’s Population Health Management strategy, including implementing and managing identified quality improvement and population health programs that reduce/prevent adverse outcomes due to inequities in care. Assist with planning, implementing, and coordinating timely, recurring member or provider-facing interventions.

• Maintaining CenCal Health’s Quality Improvement and Health Equity Transformation Program work documents.

• Assist with evaluating the effectiveness of population health and health equity initiatives using a data-driven approach. Provide input on opportunities for improvement.

• Support maintenance and promotion of CenCal Health’s value-based pay-for-performance program (Quality Care Incentive Program), including but not limited to website updates and facilitation of Primary Care Provider (PCP) quality collaboratives to drive continuous improvement of priority measures.

• Support design and development of Performance Improvement Projects and Plan, Do, Study, Act (PDSA) cycles to improve select aspects of care and reduce inequities. Create process and workflow documentation for interventions. Assist with the timely submission of required deliverables to regulators.

• Contribute to identifying and sharing best practices to improve compliance with clinically recommended services.

• Assist with the design of actionable provider gaps in care reports to support providers with prioritized member outreach.

• Facilitate training for internal staff and provider network to support department and organizational priorities.

• Maintain relationships with stakeholders and partner organizations, building commitment to shared goals and program activities.

• Serve on various committees, teams, and workgroups as appropriate.

• Other duties as assigned

Qualifications

Knowledge/Skills/Abilities

Required:

• Knowledge of quality improvement theory, strategy, and practical methods to achieve rapid-cycle improvement

• Knowledge of population health program theory, development, and practices

• Ability to establish and maintain positive professional working relationships within and outside CenCal Health

• Ability to motivate superior team performance and contribute to building a strong team dynamic.

• Ability to adapt to changes in requirements, maintain focus on responsibilities, and manage competing priorities.

• Ability to think critically, evaluate qualitative and/or quantitative data, and draw valid conclusions.

• Ability to produce informative reports including but not limited to provider bulletin articles, memos, and assessments appropriate to the target audience.

• Effective oral and written communication and presentation skills

• Outstanding interpersonal, service excellence behavior, and customer service skills

• Must be self-motivated, organized, and detail-oriented.

• Adheres to HIPAA requirements and maintains confidentiality of all data.

• Proficiency in Microsoft Word, Excel, and PowerPoint

• While this is a hybrid position, it requires the ability to travel within the service area as needed (e.g., in-person training)

Desired:

• Knowledge of Medi-Cal/Medicaid or Medicare managed care

• Knowledge of NCQA Accreditation Standards

• Knowledge of NCQA HEDIS Technical Specifications and medical record review

• Bilingual in Spanish

Education and Experience

Required:

• Bachelor’s Degree in a job-related field

• One (1) year of project management or program planning experience

• Two (2) years’ work experience in a healthcare setting with an emphasis in quality improvement/population health/care management setting working with diverse populations or a combination of academic, professional, or work experience.

Desired:

• Experience in Medicare or Medicaid/Medi-Cal managed care

• Experience collaborating with community-based organizations.

• Experience with regulatory audits (e.g., DHCS, NCQA)

• Experience with electronic medical records systems

Salary : $67,294 - $97,576