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Description

Manager Payment Transformation

The Manager Payment Transformation is accountable for providing financial pricing performance and accounting for CommonSpirit Health (CSH) providers. Leads the accounting and performance analysis activities for value-based agreements (VBA) and initiatives. Develops, recommends and assists with implementing strategies for maximizing reimbursement and market share from value-based programs and payment models. Monitors VBA participation and performance across the system using standardized tracking and reporting tools. Develops new value-based initiatives with payers that are consistent with established strategic priorities. Provides education to key stakeholders. Leads special projects for the senior leadership of the organization as requested.This position will serve and support all stakeholders through ongoing educational and problem-solving support for value-based arrangements. Requires daily contact with senior management, physicians, hospital staff, and managed care/payer strategy leaders. Must handle adverse and politically difficult situations, as the work may have a direct impact on individual physician incomes, along with directly impacting the financial performance of CSH. Must take accountability for designated reimbursement and accounting systems and must be proficient in reading, interpreting, and formulating complex computer system programming/rules. Experience•Strong background in financial healthcare reimbursement analysis is required, including an understanding of national standards for value-based provider reimbursement methodologies•Intermediate level working knowledge of SQL and Excel.•Intermediate knowledge of value-based arrangements, including shared savings, bundled payments, pay-for-performance, and capitation.•Must be able to lead and coordinate projects through various complex and challenging situations to completion under time-sensitive deadlines. Bachelor's degree in related major. Apply now with Requisition #  2019-R0257832

Senior Director, Payer Contracting

The Senior Director, Payer Contracting is responsible for all aspects of payer contracting for Privia Health for designated payers and/or Privia Markets. This includes but is not limited to, development of contract strategy, negotiation, analysis and administration of all fee-for-service and risk/incentive-based payer contracts. The position also collaborates with senior leadership in Business Development, Healthcare Economics and Value Based Care to identify and analyze contracting strategy and expansion opportunities (e.g., entrance into new markets through the development of new payer relationships).
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Strategic Operations Manager - Population Health

As a Strategic Operations Manager, you will be responsible for executing ACO performance, strategy, and working with all team members to ensure that ACO processes are in place for all operational aspects. Additionally, you will oversee payer relationships to ensure alignment in initiatives, priorities and contracting. You will have oversight for Board and committee presentations, as well as presentations to hospital executive leaders. Based in Raleigh, NC, WakeMed Key Community Care (WKCC) is the most successful accountable care organization (ACO) in North Carolina and boasts the third lowest financial benchmark for Medicare Shared Savings Programs (MSSP) in the country. With more than 200,000 covered lives, WKCC scored 100% on 2018 MSSP quality measures and includes only Primary Care Physicians. Established to deliver better outcomes, better value and a better patient experience, WKCC brings together more than 420 primary care providers with a leading health system and an additional 750 specialty care providers. Featuring a private, not-for-profit health system and a dedicated group of both employed and independent physicians, WKCC is focused on ensuring that patients, especially the chronically ill, get the right care at the right time at the right level, while avoiding unnecessary duplication of services and preventing medical errors. To learn more please visit www.wakemed.org\careers.

Qualifications:

• 5 Years Related Position Experience and 5 Years Management Required•Bachelor’s Degree in Business Administration or Related Field Required

Work Schedule:

• Hours of Work: Monday – Friday, 8:30am – 5:00pm
• Weekend Requirements: As Needed
• Call Requirements: As Needed

Innovation flourishes here, and we want your hard-earned experience and gained skills to advance further with our team. For more information and to apply, please visit us online at jobs.wakemed.org and reference job ID: 32842. EOE

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Director of Population Health Clinical Services

As a Director of Population Health Clinical Services, you will provide leadership, oversight and strategic direction to a coordinated Population Health Management care model that spans the continuum of care designed to improve quality, reduce cost, and promote patient and provider satisfaction. You will be responsible for partnering with key physician and practice stakeholders in setting the strategy for an effective continuum-based care model including but not limited to: Care Transitions, Complex Case Management, Condition Management, Care Coordination and Community Based Resources. Based in Raleigh, NC, WakeMed Key Community Care (WKCC) is the most successful accountable care organization (ACO) in North Carolina and boasts the third lowest financial benchmark for Medicare Shared Savings Programs (MSSP) in the country. With more than 200,000 covered lives, WKCC scored 100% on 2018 MSSP quality measures and includes only Primary Care Physicians. Established to deliver better outcomes, better value and a better patient experience, WKCC brings together more than 420 primary care providers with a leading health system and an additional 750 specialty care providers. Featuring a private, not-for-profit health system and a dedicated group of both employed and independent physicians, WKCC is focused on ensuring that patients, especially the chronically ill, get the right care at the right time at the right level, while avoiding unnecessary duplication of services and preventing medical errors. To learn more please visit www.wakemed.org\careers.

Qualifications:

• 3 Years Management – Direct Area of Responsibility Required – And Clinical – Case Management And Supervisory Preferred
• Master’s Degree in Health Administration Or Nursing Or Public Health Required
• RN License Preferred 

Work Schedule:

• Hours of Work: Monday – Friday, 8:30am – 5:00pm
• Weekend Requirements: As Needed
• Call Requirements: As Needed

Innovation flourishes here, and we want your hard-earned experience and gained skills to advance further with our team. For more information and to apply, please visit us online at jobs.wakemed.org and reference job ID: 33103. EOE

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VP, Medical Director Population Health

Responsible for overall development and strategic leadership of population health and Clinically Integrated Network (CIN) management. Responsible for providing the operational oversight and direction for design, facilitation, and support of a population health management program. Accountable for sponsoring and championing local market and system-wide initiatives including cultivating the support necessary to achieve the desired operational objectives for each initiative. Accountable for developing operational plans which address the market opportunities/challenges and align with the established population health goals. 

Essential Job Functions
Pursues clinical integration activities with the CIN members. In partnership with the Chief Population Health Officer and VP of Clinical Services, creates an integrated multi-disciplinary care model to improve quality and efficiency of care for the CIN attributed lives

Manages the Group Network Integration Officers in each of the Groups who are responsible for the overall network development, transformation, and integration strategy for the Group’s clinically integrated network. Additionally, theses executives are responsible for the Group’s performance on value-based contracts focusing on delivering on cost and quality.

Coordinates the efforts of the CIN Boards in developing a network development plan, which includes retention, recruitment, and succession planning of physicians as well as other services in the care continuum such as post-acute providers.

Partners with physicians and takes an active role in the recruiting and retention of physicians into the CIN

Works closely with the Credentialing Committee to ensure that appropriate credentialing of physicians and peer review processes occur

Drives operational excellence by executing on business and operational plans that support the population health strategy for the ministry.

Drive performance improvement, innovation and clinical transformation efforts that achieve the goals and objectives of the value-based contracts that are in place throughout the system.

Oversees the maintenance of the provider networks, including, but not limited to: agreement maintenance, provider database maintenance, liaison with Central Verification Office and Payer Enrollment team, liaison with providers and office staff for issue resolution, liaison with payers and internal personnel for issue resolution, education of office staff and providers on new programs, services, operational and compliance requirements, and developing appropriate reports to monitor and assess network activities.  

 Develops and maintains strong relationships with physicians, corporate staff to influence decisions and meet organizational mission and vision.  Pursues opportunities for partnerships, collaborations and new programmatic opportunities that may enhance the CIN.

Member of the Bon Secours Mercy Health Ambulatory Informatics Committee. 

Employment Qualifications
Required Minimum Education: BA/BS, Related Field 

Preferred Education: Master’s, Related Field 

Minimum Qualification: Years of Experience - 10+ years related experience, including 7-10 years in leadership role with significant business impact 

Mercy Health is an equal opportunity employer.

We’ll also reward your hard work with:

• Great health, dental and vision plans
• Prescription drug coverage
• Flexible spending accounts
• Life insurance w/AD&D
• An employer-matched 403(b) for those who qualify.
• Paid time off
• Tuition reimbursement
• And a lot more

Apply Now!

VP, Population Health Operations

Responsible for overall development and strategic leadership of population health and Clinically Integrated Network (CIN) management. Responsible for providing the operational oversight and direction for design, facilitation, and support of a population health management program. Accountable for sponsoring and championing local market and system-wide initiatives including cultivating the support necessary to achieve the desired operational objectives for each initiative. Accountable for developing operational plans which address the market opportunities/challenges and align with the established population health goals.

• Pursues clinical integration activities with the CIN members. In partnership with the Chief Population Health Officer and VP of Clinical Services, creates an integrated multi-disciplinary care model to improve quality and efficiency of care for the CIN attributed lives
• Manages the Group Network Integration Officers in each of the Groups who are responsible for the overall network development, transformation, and integration strategy for the Group’s clinically integrated network. Additionally, theses executives are responsible for the Group’s performance on value-based contracts focusing on delivering on cost and quality. 
• Coordinates the efforts of the CIN Boards in developing a network development plan, which includes retention, recruitment, and succession planning of physicians as well as other services in the care continuum such as post-acute providers. 
• Partners with physicians and takes an active role in the recruiting and retention of physicians into the CIN
• Works closely with the Credentialing Committee to ensure that appropriate credentialing of physicians and peer review processes occur
• Drives operational excellence by executing on business and operational plans that support the population health strategy for the ministry.
• Drive performance improvement, innovation and clinical transformation efforts that achieve the goals and objectives of the value-based contracts that are in place throughout the system.
• Oversees the maintenance of the provider networks, including, but not limited to: agreement maintenance, provider database maintenance, liaison with Central Verification Office and Payer Enrollment team, liaison with providers and office staff for issue resolution, liaison with payers and internal personnel for issue resolution, education of office staff and providers on new programs, services, operational and compliance requirements, and developing appropriate reports to monitor and assess network activities.   
• Develops and maintains strong relationships with physicians, corporate staff to influence decisions and meet organizational mission and vision.  Pursues opportunities for partnerships, collaborations and new programmatic opportunities that may enhance the CIN.
• Member of the Bon Secours Mercy Health Ambulatory Informatics Committee. 

This document is not an exhaustive list of all responsibilities, skills, duties, requirements, or working conditions associated with the job. Employees may be required to perform other job related duties as required by their supervisor, subject to reasonable accommodation.

Essential Job Functions 

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Reports to the Dartmouth-Hitchcock Health Chief Strategy Officer and Chief Clinical Officer.Responsible for optimizing D-HH performance under its commercial and government risk contracts and its employer sponsored health plans. Performance metrics include achieving quality, patient/employee experience, utilization and financial goals by working collaboratively with clinical and administrative leaders across the D-HH system.Key Partners: Site Medical Directors, Primary Care Department Leaders, VPs in Care Management, Payment Innovation, IS, Analytics, Total Rewards

Responsibilities:

• Designs and implements the infrastructure necessary to effectively manage costs, utilization, and quality associated with risk contracts-Supervises centralized ACO support staff and services and identifies the appropriate mix of central vs. practice based resources
• Develops tools and processes to optimize performance under risk contracts
• Develops a routine, robust reporting package with actionable data to identify improvement opportunities and monitor performance-Analyzes data and works with clinical leaders and care management staff to prioritize and implement processes and care models to lower cost and improve quality metrics-Meets regularly with clinical leaders and teams to monitor performance against goals-Uses performance benchmarks to assess best practice goals and targets
• Works with D-HH Contracting to assess and advise on contracted total cost of care targets Engages with insurers to facilitate care management processes and opportunities

Qualifications:

• A clinician with a Master’s in health administration, public health, or related field.
• A minimum of five (5) years’ experience in a senior level healthcare or health plan position responsible for performance under value-based reimbursement.Dartmouth

Hitchcock is an equal opportunity employer. Apply Now!

The Director of Quality Improvement is responsible for designing, implementing, and monitoring the comprehensive Quality improvement plan for Enterprise Population Health (EPH) in Illinois. This position reports directly to the Vice President of Government and Value Based Programs, and implements programs to ensure quality and financial attainment of contract and/or program goals. Coordinates and leads the IL Quality Improvement Committee, and has direct oversight over the Manager of Quality Data and Manager of Medical Neighborhood and their respective teams. Accountabilities include:

1. Designs and implements a dynamic and high functioning Quality Improvement Program to assure the highest quality of care is provided.
2. Implements quality programs to achieve targets and provide measurements related to AAH Population Health strategy. Leads all communications and project management of quality improvement initiatives.
3. Provides leadership, development, and coordination for system wide resources to effectively manage and deliver care to achieve quality outcomes and meet EPH goals for assigned risk payer contracts and establishes and maintains relationships with payers to partner in improving overall quality and efficiency of care.
4. Engages and collaborates with key leaders (including Population Health, Medical Directors, Medical Groups, Hospital Leaders) throughout the organization to positively impact and improve the delivery of high quality patient care. Assists in the ongoing development and design of appropriate reports, dashboards, and tools to drive improved clinical quality and meet assigned payer contracted population goals specifically around STARS, HEDIS, and HCC/RAFs.

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The DVACO Administrative Fellowship is a 1-year program designed for recent graduates of MHA, MBA, MPH, MS-POPH, or similar healthcare programs to build a foundation for a career in population health. The position emphasizes skills related to population health management, healthcare business planning, and leadership skills. Based on interests, the program may include rotations through various DVACO departments including Care Coordination, Practice Transformation, Data Analytics, and Clinical Quality, and the opportunity to become acquainted with each of our member hospitals. In addition to these rotations, the Fellow can tailor his/her experience through various projects related to topics such as quality oversight, data reporting, performance improvement, physician engagement, informatics, network development, and contract/payer relations. This design gives the Fellow the opportunity to build fundamental communication, analytic, and problem-solving skills as well as an understanding of the ACO environment and population health strategies. To complement on-the-job training, fellows are involved in Board and other Administrative meetings. 

Qualifications and Education Requirements

• Recent graduate of MHA/MPH/MBA/MS-POPH Accredited, or similar, degree program
• Recent graduate of a Commission on the Accreditation of Healthcare Management Education (CAHME) program is preferred  

Preferred Skills

• Analytical thinking
• Microsoft Office
• Proficient in Microsoft Excel
• Project Management
• Performance Improvement Knowledge  

Application Materials 

In order to be considered for the 2020 Administrative Fellowship, the following items must be attached to this application: 

1. Current Resume
2. Three letters of Recommendation: at least one from a graduate professor and a current or former employer
3. Personal Statement: 1-2 pages addressing personal career goals and your view on the importance of population health management
4. Official Graduate Transcript
1. Applications due Friday, September 20, 2019 at 11:59pm EST
2. Phone Interviews are the last week of September 2019
3. On site Interview date Thursday, October 10, 2019
4. Selection data by October 31, 2019

To apply on line please go to https://www.mainlinehealth.org/careers Job ID 49125 Applicants must certify that they have not used tobacco products or nicotine in any form in the 90-days prior to submitting an application to DVACO. This will be verified during pre-employment testing. We are an Equal Opportunity Employer.

Broward Health is Broward County’s largest healthcare services provider and is one of the nation’s top public health systems. We are seeking a qualified Vice President, Managed Care to join our team.Full-time – Monday – Friday – Days – Weekend requirements as needed

The Vice President, Managed Care will be responsible for planning and directing the effective development, execution, implementation and administration of all aspects of the comprehensive managed care plan of the organization. Maintains existing relationships and identifies opportunities for business development. Collaborates with all levels of the organization to ensure the strategic alignment and integration across Accountable Care Organization (ACO) related projects/programs. Supports adherence to Broward Health’s compliance and ethics program, policies, procedures and Code of Conduct.Requirements:Bachelor’s degree obtained through a formal four-year program.  10 years of related experience

Thank you for your interest in Broward Health. Broward Health is an Equal Opportunity Employer and Affirmative Action procurer of goods and services. Apply Now!

Job Details

• Care transition coaching and coordination.
• Population management
• Conduct targeted reviews of medical documentation
• Perform psycho-social assessment, identify patients in need of behavioral health support and refer as appropriate
• Workflow process facilitation
• Health plan clinical liaison; utilize health plan data and portals.

Minimum Qualifications

• RN required
• Valid driver's license and evidence of automobile insurance
• Associates in Nursing required
• Local and out-of-state travel as needed. Participation in after-work activities as required. Evening and weekend work as necessary
• Proficient in email communications and internet usage along with basic use of Microsoft Excel and Word
• Knowledge of information technology to evaluate care effectiveness (care process, outcomes and cost) for individual users of health care and patient populations
• Certification as needed or available for Health Coaching or Population Health Management
• Basic Life Support (BLS) for the Healthcare Provider certified or obtained by the end of the orientation period
• Knowledge of confidentiality, legal and liability issues
• Preferred Qualifications
• BSN
• 5 years of clinical and case management/health coach experience
• Clinic/Physician office, home care, public health and/or social service experience preferred.
• Experience in patient education preferred
• Experience with Allscripts Enterprise, Meditech, IDX and McKesson Medventive PHM preferred
• Certification in case management (CCM), public health and/or community health preferred

Trinity Health's Commitment to Diversity and Inclusion. Trinity Health employs about 133,000 colleagues at dozens of hospitals and hundreds of health centers in 22 states. Because we serve diverse populations, our colleagues are trained to recognize the cultural beliefs, values, traditions, language preferences, and health practices of the communities that we serve and to apply that knowledge to produce positive health outcomes. We also recognize that each of us has a different way of thinking and perceiving our world and that these differences often lead to innovative solutions.

Trinity Health's dedication to diversity includes a unified workforce (through training and education, recruitment, retention and development), commitment and accountability, communication, community partnerships, and supplier diversity.

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The Population Health Nurse Supervisor is a professional nurse who fulfils the responsibilities of a Population Health Nurse, provides supervision to the department's care management colleagues and acts under the direction of the Medical Director and Executive Director. Work includes, but is not limited to, oversight of day to day workflows, addressing staffing issues, developing work groups and collaborating with the Director on associate performance issues. Direct Supervision of Population Health Nurse Staff includes:

• Responsible for the daily operations of the assigned care management staff assuring that the staff is delivering the highest quality care management services to patients, families, physicians and other members of their team
• Available to front line staff, which may include travel to local ambulatory sites for problem solving within the areas of patient, family, insurance, resource, educational and or provider related issues
• Provides support to the care management staff on a daily basis which includes evaluation, development, mentoring, coaching, counseling and disciplinary actions
• Assists in recruitment, interviewing, and selection of personnel
• In collaboration with director and with input from stakeholders, prepares performance evaluations
• Provides on-going clinical supervision to the Population Health Nurses in both ambulatory and centralized settings and assists with the team's professional growth, development and on-going competence
• Works with colleagues in identification of quality issues and problem solving
• Organizes work groups that address on-going quality and process improvement initiatives.

MINIMUM KNOWLEDGE, SKILLS AND ABILITIES REQUIRED

• Current unrestricted license by the State of Florida as a registered nurse
• Bachelor's degree required
• Must lead by example and possess superior customer service skills and professionalism
• Must exhibit flexibility to adapt to ongoing changes and work in a fast-paced, customer driven environment
• Must have interpersonal skills to drive collaboration, commitment, and productivity when working with cross-functional teams, customers, and end users
• Must possess leadership qualities including time management, verbal and written communication skills, listening skills, problem solving, decision-making, diplomacy, priority setting, work delegation and work organization

Experience in patient education is required.

Apply Now!.

The SERPA-ACO Chief Medical Officer is the clinical leader for the ACO’s population health management strategies including provider engagement & outreach, quality and utilization reporting, aligned incentives, and clinical strategies to effectively manage the ACO's attributed patient populations. This visionary leader will help guide the organization through changes in healthcare. Serving as the champion and expert in primary care and specialty care collaboration in efforts to support effectiveness and efficiency. Experience with designing effective population health or value based care models and protocols to decrease inappropriate utilization and/or enhance quality of outcomes. Experience successfully managing cost of care and quality and negotiating the terms of cost and quality in value based agreements. Ability to review data and translate opportunities into actionable tactics. Demonstrated commitment to patient-centered model of care delivery with proven quality management/improvement record. Be knowledgeable and provide guidance on new government and commercial payment models. Be responsible for working with physician and mid-level outliers. Working closely with the physician members encouraging and directing them to high quality care and best practices through education and clinic visits. Assist in recruitment of new clinics to become members of the ACO. Serve as the liaison with other CMO’s on a statewide and national basis as needed, networking with other health care entities. Five years of healthcare practice and leadership experience preferably involving the ambulatory and inpatient domains. MD or DO with Active Nebraska State license (to be obtained within the first year of employment) A current unrestricted license to practice medicine. Send resume to [email protected]