Population Health Strategist Job at PacificSource Health Plans
Salary Range:
$71,726.60 - $125,521.55
Looking for a way to make an impact and help people?
Join PacificSource and help our members access quality, affordable care!
PacificSource is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to status as a protected veteran or a qualified individual with a disability, or other protected status, such as race, religion, color, national origin, sex, sexual orientation, gender identity or age.
Diversity and Inclusion: PacificSource values the diversity of the people we hire and serve. We are committed to creating a diverse environment and fostering a workplace in which individual differences are appreciated, respected and responded to in ways that fully develop and utilize each person’s talents and strengths.
Position Overview: Responsible for successful execution, coordination and support of PacificSource’s clinical/quality improvement initiatives, across all lines of business. Key areas of focus include oversight and management of provider clinical engagement and performance on patient populations. This is done through collaborating with targeted provider groups to guide and develop practice specific strategies designed to optimize clinical quality outcomes, risk assessment performance, and clinical outcomes via care management and cost containment. Work directly with internal PacificSource departments to build/strengthen relationships with strategic provider partners; ensure effective education, analyze and generate specific clinical reports and proactively identify clinical improvement opportunities that support PacificSource’s strategic goals. Assist with the development and execution of region specific strategies and practice coaching.
Essential Responsibilities:
- Assist with the development and execution of enterprise wide provider campaigns focused on improving clinically oriented improvement and outcomes. (HEDIS, CAHPS/HOS scores and other identified quality improvement measures)
- Provide ongoing training, coaching and high-touch support to network providers and clinic staff toward the development and implementation of improvement initiatives (clinical quality, member experience, clinical workflows, and documentation/coding practices) within their own practices.
- Establish credible, consultative relationships with network physicians and clinic staff as a subject matter expert on clinical quality improvement measures and risk assessment including the technical reporting and documentation requirements NCQA (HEDIS and CAHPS), risk adjustment.
- Collaborate with multiple departments (Risk Assessment, Care Management, Utilization Management, Pharmacy, and Medical Directors) to develop and deploy aligned quality performance programs to drive member care outcomes and improved provider satisfaction.
- Maintain a detailed understanding of all shared data elements (clinical outcomes, ICD-10 coding, and documentation) and the systems necessary to support actionable interventions,
- Support internal initiatives to improve the collection and reporting of supplemental HEDIS data as related to provider populations.
- Evaluate quality programs, initiatives and interventions utilizing multiple data sources to determine the effectiveness of activities and make recommendations to improve outcomes for CMS Stars, NCQA, QIM (HEDIS, CAHPS).
- Lead internal/external cross functional teams with regional focus to develop and deploy annual improvement plans with performance metrics, monitor risk, deploy mitigation strategies and elevate to joint operating committees as needed
- Support all clinical and quality dyads with provider payer partnerships to optimize engagement, drive performance and improve provider/member experience in service to growth strategy.
Supporting Responsibilities:
- Represent Quality Improvement internal committees and workgroups.
- Meet department and company performance and attendance expectations.
- Follow the PacificSource privacy policy and HIPAA laws and regulations concerning confidentiality and security of protected health information.
- Perform other duties as assigned.
Work Experience: Minimum of 5 years of experience in the healthcare industry. Health care clinic experience required. Operational leadership or clinic manager preferred and/or other Population Health Program implementation experience.
Education, Certificates, Licenses: Bachelor degree in healthcare administration or similar field is required or equivalent work experience. Master’s degree and/or Clinical license preferred.
Knowledge:
Knowledge/experience with quality improvement initiatives in the clinic setting including clinical quality outcomes and patient experience. Knowledge of national and state quality measures such as CMS Stars, NCQA, HEDIS, CAHPS/HOS required. Strong computer skills using Word, Excel, and PowerPoint. Experience with medical billing, claims processing systems, data analytics, and health care information strongly preferred. Knowledge and experience implementing continuous improvement efforts or LEAN concepts strongly preferred. Must have strong analytical, influencing, and problem solving skills. Understanding of quality initiatives, evidence based medicine and care coordination required. Demonstrated ability to effectively communicate with all levels of a staff and management including executive leaders. Proven ability to learn new healthcare information systems and work with multiple business systems. Must be self-motivated, organized, and detailed oriented.
Competencies
- Building Trust
- Building Customer Loyalty
- Facilitating Change
- Driving for Results
- Building Strategic Work Relationships
- Leveraging Diversity
- Decision Making
- Building a Successful Team
- Aligning Performance for Success
- Continuous Improvement
Environment: Work inside in a general office setting with ergonomically configured equipment. Travel is required approximately 25-50% of the time.
Our Values
We live and breathe our values. In fact, our culture is driven by these seven core values which guide us in how we do business:
- We are committed to doing the right thing.
- We are one team working toward a common goal.
- We are each responsible for customer service.
- We practice open communication at all levels of the company to foster individual, team and company growth.
- We actively participate in efforts to improve our many communities-internally and externally.
- We actively work to advance social justice, equity, diversity and inclusion in our workplace, the healthcare system and community.
- We encourage creativity, innovation, and the pursuit of excellence.
Physical Requirements: Stoop and bend. Sit and/or stand for extended periods of time while performing core job functions. Repetitive motions to include typing, sorting and filing. Light lifting and carrying of files and business materials. Ability to read and comprehend both written and spoken English. Communicate clearly and effectively.
Disclaimer: This job description indicates the general nature and level of work performed by employees within this position and is subject to change. It is not designed to contain or be interpreted as a comprehensive list of all duties, responsibilities, and qualifications required of employees assigned to this position. Employment remains AT-WILL at all times.
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