What are the responsibilities and job description for the Population Health Director position at Sante Health System, Inc?
NOT A REMOTE POSITION.
A challenging and rewarding opportunity awaits a new Director of Quality Management at Sante Health System in Fresno, CA. This leadership role partners closely with health plans and medical providers to analyze data, identify trends, and develop strategies that improve health outcomes across Sante's ACO, HMO, and PPO populations. The Director will oversee and drive quality improvement initiatives, enhance Medicare Risk Adjustment and HEDIS measure performance, and support overall compliance and efficiency within clinical programs. Key responsibilities include identifying areas for improvement, leading change management efforts, and streamlining program activities to support provider performance and patient care outcomes. This role also tracks, evaluates, and presents results of improvement initiatives to executive leadership, health plan partners, and provider groups.
QUALIFICATIONS
- Bachelor's Degree in relevant health care area; Master's Degree preferred.
- Minimum 5 years in a healthcare industry experience; Population Health role preferred.
- Minimum 3 years of management/supervisory experience.
- Minimum 3 years of technical duties related to data analysis, health care informatics and billing cycle data.
PERFORMANCE REQUIREMENTS
Knowledge, Skills & Abilities
- Analytical Skills: Ability to interpret data, identify trends, and develop insights.
- Communication and Interpersonal Skills: Ability to communicate effectively with diverse audiences and build relationships with stakeholders.
- Project Management Skills: Ability to plan, organize, and manage projects effectively.
- Computer Proficiency: Proficiency in using data analysis software, spreadsheets, and databases.
- Healthcare Systems: Understanding of the healthcare system, including insurance, care delivery models, and payment systems.
- Public Health Principles: Understanding of public health concepts, including epidemiology, disease prevention, and health promotion.
- Data analytics and reporting tools, such as SQL and Python.
ESSENTIAL DUTIES AND RESPONSIBILITIES
- General responsibilities
- Coordinate health plan initiatives for all lines of business.
- Accountable Care Organization (ACO)
- Commercial HMO
- Medicare Advantage
- Supervise and evaluate department staff.
- Assure Sante meets all regulatory requirements pertaining to Quality Management.
- Population Health program planning and execution.
- Lead Quality Performance Initiative
- Design and implement programs and initiatives aimed at improving health outcomes, such as disease prevention programs, chronic disease management, and access to care.
- Work with various stakeholders, including healthcare providers and payers, to identify needs, develop collaborative strategies, and ensure effective implementation of programs.
- Collect, analyze and interpret data related to health outcomes, demographics, and healthcare utilization to identify trends, patterns, and areas for improvement.
- Track key performance indicators (KPIs), monitoring program outcomes, and evaluating the effectiveness of interventions to identify areas for improvement.
- Develop and deliver educational materials, conduct community outreach, and work with healthcare providers to promote health awareness and encourage participation in programs.
- Initiate programs and process to increase Medicare Advantage Risk Adjustment Factor rates.
- Manage Sante Quality Management Program
- Oversee the processing of member complaints and grievances including health plan complaint and grievance information requests.
- Maintain and update the Sante Quality Management Policies & Procedures Manual.
- Manage all health plan audits of the Sante quality program.
- Provide all support and reporting for the Sante Quality Improvement Committee.
- Provide support for the Sante Foundation Medical Group (SFMG) Quality Improvement Program
- Support and oversight of the practice-site specific QI programs.
- Develop and implement QI processes for SFMG providers as needed.
- Maintain strictest confidentiality.
- Attend professional development events.
- Participate in committees and task forces as appropriate.
- Develop IPA provider engagement initiatives through various methods outreach efforts.
- Perform other job-related duties as requested.
ABOUT SANTE HEALTH SYSTEM
Sante Health System is a Management Services Organization that serves multiple clients. "Sante" is the French word for health. Our name symbolizes our commitment to good health, progressive care, and leadership in our community.
Sante is one of the largest health care claims and billing management companies in Central California. The strength of
Sante is the extraordinary network of physicians, health plans, and other health service providers it offers the people of our valley. Sante coordinates with physicians, health plans, hospitals, and ancillary providers to ultimately benefit the patient in a managed care environment. Sante Health System provides numerous client services such as billing, claims processing, contracting, credentialing, finance, human resources, information services, marketing/communications, physician services, practice management, provider relations, quality improvement, and utilization management.
Sante is celebrating 30 years of service to the community. We deeply understand that we would not be successful in enhancing the quality of life of our patients without our incredible team. Therefore, we have created a work culture that is comprised of talented, driven, dedicated, innovative, and service-driven professionals. We provide competitive pay, excellent benefits including medical, dental, vision, and life insurance, 401k retirement plan, paid time off, and opportunities for advancement. Being part of our team is like being part of a big family. Join our team and make Sante Health System your home away from home.
READY TO JOIN OUR TEAM?
We understand your time is valuable, so we have a very quick and easy application process. If you feel that you would be right for this job in health care, please fill out our initial 3-minute, mobile-friendly application. We look forward to meeting you!
www.santehealth.net
https://santehealth.isolvedhire.com/jobs/1535411