Responsible for consulting with providers to improve the effectiveness and efficiencies of provider practices and clinical processes.
Primary duties may include, but are not limited to: Obtains and analyzes practice specific cost and quality data and reports for cost of care and quality opportunities, helps practice to target high risk members and gaps in care based on reports provided, supports practice implementation of population health management, care coordination and care management strategies, identifies action plans for providers to implement to improve cost, quality and the patient experience and participates in design, development, and implementation of community learning forums. Serves as the point of contact for providers and primary care practices for program on boarding, facilitation of routine meetings between client and the provider office. Serves as the subject matter expert and liaison with Care Management to facilitate clinical processes between the company and the provider office, creates and hosts tailored learning opportunities to support the deployment of program interventions, hosts collaborative learning events that allow practices to learn from one another and national experts, use of the Provider Care Management Solutions (PCMS) tool and other data sources, and provides technical support for the Care Delivery Transformation program within the Enhanced Personal Health Care program. Collaborates with Enhanced Personal Health Care team and other program stakeholders, including but not limited to: CDT Market lead, Medicare Team, Enhanced Personal Health Care Provider Solutions team to meet provider and practice service needs.
Requires a BA/BS; 5-10 years health care experience; or any combination of education and experience, which would provide an equivalent background. Physician environment experience in practice transformation/quality improvement, ambulatory care setting quality and efficiency metrics, population health and care management structures, data analytics preferred. Desired additional skills: Medicare knowledge including HEDIS/STARs and HCC coding and medical cost management strategies. Clinical background and/or MBA, Six Sigma, or PMP not required but a plus.