Population Health Manager

Overview

We are recruiting for a leader to join our Quality Improvement department as Population Health Manager in Fresno, CA.

The Population Health Manager is responsible for the development and management of value-based care-driven initiatives. The manager will partner closely with the Quality Improvement Director to guide multidisciplinary teams through various Quality Improvement projects. Will play a key role in ensuring that the organization performs at the highest levels on standardized, national measures of clinical quality care assigned to UHC.

The Population Health Manager will plan, implement, evaluate, and continuously improve many simultaneous projects to achieve strategic priorities for the UHC. These initiatives will include various activities related to strategic planning, practice transformation, change management, data systems, and quality/process improvement.

Responsibilities

• In collaboration with the Director of Quality, ensure QI Plans meet clinical standards of care and achieve the desired outcome for UHC for Health Effectiveness Data and Information Set (HEDIS), and HEDIS STARS.
• Work with leadership to improve the overall Risk Adjustment Factor (RAF) score of the Medicare and Medicare Advantage members.
• Work with the UHC leadership in implementing a Population Health platform.
• Manage and maintain the Population Health platform.
• The individual in this position will ensure all program deliverables/deadlines are met and communications with internal and external stakeholders are appropriate and efficient.
• They will work with other departments to maximize quality metrics and financial ROI across all value-based programs.
• The Population Health Manager will oversee a team of Population Health Specialist(s) and Coordinator(s) responsible for program management activities within value-based contracts.
• Provide feedback and collaborate with EHR and data teams to ensure reports are accurate, meaningful, and actionable.
• Facilitate site meetings and collaborate with other department leaders to develop process improvement initiatives to enhance clinical quality measures.
• Coordinating tracking and reporting of clinical outcomes and follow-up of corrective action plans from contracted Independent Physician Associations (IPAs) and Health Plans.
• Partner with IPAs and Health plan management to provide participation decision recommendations for any new value-based programs by analyzing operational needs and developing financial forecasting models
• Develop strategies and advise on workflows to position the practice to realize quality-based incentives.
• Managing value-based care programs and goals, including payer relationships, making finance and budgeting key.Competency in gathering information and understanding context from several sources with the ability to analyze this information, draw conclusions, and make recommendations is required.
• Review and evaluate performance on population health measures by meeting certain clinical performance thresholds on quality measures (e.g., screening, immunization, etc.).
• A high degree of comfort, experience, and credibility in interactions with healthcare leaders, including "C" level executives and Medical Directors, is essential to success.
• Participates in staff and management meetings related to Population Health and Quality Improvement activities.
• Work with Data to develop methods for data collection and extract data as required for IPA and Health Plan partners.
• Evaluate programs/initiatives for effectiveness and ensure compliance with state and federal regulatory agencies.
• Report, respond, and work with Health Plans in mitigating clinical quality gaps.
• Produces summary program reports summarizing key goals, accomplishments, and outcomes at monthly intervals.
• Analyze health data and identify policies and programs to improve outcomes and address inequities.
• Reviewing insurance claim records to identify areas of improvement for reducing costs, improving efficiency, and identifying any coding gaps.
• Identifying gaps in care for patients with complex health needs to ensure that they receive appropriate follow-up care from specialists or other providers.
• Analyzing data from disease registries and other sources to identify trends in disease prevalence or other health concerns that may require action.

Qualifications

EDUCATION:

• Bachelor's degree in health sciences, business, healthcare administration, health information management.
• Master's Degree preferred.
• Certified Coder preferred.

LICENSE/CERTIFICATION:

• Valid driver's license 

PRIOR EXPERIENCE:

• Three (3) years of experience in Quality, Population Health, or Value-Based field.
• Experience with HEDIS, RAF and HEDIS STARS preferred.

SKILLS:

• Experience with HEDIS or value-based clinical performance measures
• Comfortable understanding of Code sets (e.g., CD 100, CPT, CDT, etc.), especially Hierarchical Condition Category (HCC) coding.
• Comfortable understanding of Risk Adjustment Factor (RAF) scores
• Advanced Word/Excel PowerPoint experience
• Competency in gathering information and understanding context from several sources with the ability to analyze this information, draw conclusions, and make recommendations is required.
• Exceptional written and verbal communication skills with peers, executives, and other key stakeholders are required.
• Must demonstrate advanced problem-solving skills and exceptional attention to detail
• Must be flexible and maintain positive working relationships with the ability to comfortably navigate ambiguity, significant autonomy, and a fast-paced, changing environment
• Must have strong project management and prioritization skills combined with the ability to ensure sensitive timelines are met
• Exceptional written and verbal communication skills with peers, executives, and other key stakeholders are required

The pay range for this Exempt position starts at $64,480 a year Our salary ranges are dependent on knowledge, skills, and experience.

In addition, our comprehensive benefits package for regular status employees includes:

• Medical, Dental, and Vision insurance with low premium cost
• Paid time off and paid holidays
• 401k plan with matching contribution
• Educational Assistance
• Employee discounts and more!

Salary : $64,480