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Director, Enterprise QM Provider Engagement

Job Description

Develop enterprise provider network and practice-level physician engagement strategy, infrastructure, model and accompanying tools to drive success. Working directly with key provider partners, facilitate population health management and member growth capabilities through practice transformation activities. Develop cross-organizational high-impact provider incentive and education programs to drive quality, risk stratification, and clinical effectiveness improvement; execute across enterprise provider network. Lead a high-value team of Physician Practice Engagement Associates to achieve optimized Quality, Stars, Risk Adjustment (Coding Accuracy), Clinical Outcomes Performance, and CAHPS ratings. Collaborate with Quality Management, Medical Management, Finance, Product, Pharmacy, IT, Sales business leaders to align strategies and provider performance improvement priorities.

Responsibilities:

  • Design and implement physician practice engagement model, infrastructure and accompanying tools (i.e., program offerings, business intelligence and data visualization tools, checklists and scorecards) for Physician Practice Engagement team effectiveness in delivery of value-add services at physician point of care – education and training, performance reporting, practice assessments and performance improvement management.  Develop and execute set of intervention work plans to drive practice improvement of quality, risk adjustment, clinical outcomes performance (gaps in care, documentation & coding, clinical effectiveness), establish annual performance targets and manage to enterprise goals.  Ability to manage coding team for quality or coding accuracy initiatives to maximize gap closure rates.
  • Conduct practice assessments; develop, recommend and implement interventions at the practice level to improve clinical quality, efficiency, clinical effectiveness and satisfaction outcomes. Collaborate with practices to facilitate redesign efforts, support care teams, introduce population health management and support achievement towards improved financial, process and clinical outcomes. Develop and execute set of intervention work plans to drive practice performance improvements, including workflow design and redesign, electronic health record (EHR) optimization, clinical documentation, assessments, and financial performance improvement and reporting. Actively participate in cross-functional teams to conduct work and resolve root-cause enterprise and regional provider underperformance issues.
  • Partner across the organization to plan, develop and execute high-impact, industry compliant (i.e., NCQA, CMS, NYSDOH) provider quality and risk stratification incentive and education programs for Medicare STARs, Medicaid and Exchange Quality Rating System (QRS) that result in improved quality scores, outcomes and satisfaction.  Includes:  program design & alignment, budgeting, target setting, marketing/communication, provider rollout/training, progress measurement, evaluation and reporting out on trends, outcomes, and financial ROI.  
  • Lead and develop team members to drive change across multiple physician practice offices; define team objectives and measure performance to goal.  Build and manage Provider Practice team, empowering their success and growth through coaching and development.  Establish foundational relationships with key provider group leadership and enterprise leaders across stakeholder departments to influence roadmaps and empower team to advance their work. 
     

Job Requirements

Qualifications:

  • Bachelor’s Degree, preferably in a business, clinical, or related field (R)
  • Master’s Degree in Public Health, Healthcare Administration or Business Administration (R)
  • 10+ years related work experience in population health, provider practice administration, electronic medical record technologies/platforms, provider practice transformation and/or provider performance improvement and management. (R)
  • Proven experience in building and leading effective teams; 5-8 years of managerial experience, with demonstrated ability to work in a matrix management environment (R)
  • Ability to travel to offices in New York and Connecticut and across the enterprise (R)
  • Account/vendor management experience (R)
  • Proven ability to handle multiple projects simultaneously in a fast-paced environment and adjust to changes quickly while meeting deadlines (R)
  • Excellent organizational, oral and written communication and interpersonal skills (R)
  • Strong problem-solving skills and effective decision-making skills (R)
  • Ability to collaborate cross functionally and to challenge the status quo as required (R)
  • Comfortable with analyzing data, identifying trends, calculating impact and synthesizing data into actionable information (R)
  • Proficient with Microsoft Office (word processing, database/spreadsheet, presentation) (R)
  • Familiarity with business intelligence and data visualization tools (i.e., Qlikview, Tableu) (P)
  • Certified Professional Coder or Certified Risk Adjustment Coder Certified (P)

Job Snapshot

Location US-NY-New York
Employment Type Full-Time
Pay Type Year
Pay Rate N/A
Store Type Health Care
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Company Overview

EmblemHealth

EmblemHealth is a local, neighborhood health plan that has served the New York City area and surrounding communities for more than 75 years. That’s the kind of experience that makes us unique. We’re proud to be one of the nation’s largest not-for-profit health plans, serving 3.1 million people who live and work across the New York tri-state area. Learn More

Contact Information

US-NY-New York
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Snapshot
EmblemHealth
Company:
US-NY-New York
Location:
Full-Time
Employment Type:
Year
Pay Type:
N/A
Pay Rate:
Health Care
Store Type:

Job Description

Develop enterprise provider network and practice-level physician engagement strategy, infrastructure, model and accompanying tools to drive success. Working directly with key provider partners, facilitate population health management and member growth capabilities through practice transformation activities. Develop cross-organizational high-impact provider incentive and education programs to drive quality, risk stratification, and clinical effectiveness improvement; execute across enterprise provider network. Lead a high-value team of Physician Practice Engagement Associates to achieve optimized Quality, Stars, Risk Adjustment (Coding Accuracy), Clinical Outcomes Performance, and CAHPS ratings. Collaborate with Quality Management, Medical Management, Finance, Product, Pharmacy, IT, Sales business leaders to align strategies and provider performance improvement priorities.

Responsibilities:

  • Design and implement physician practice engagement model, infrastructure and accompanying tools (i.e., program offerings, business intelligence and data visualization tools, checklists and scorecards) for Physician Practice Engagement team effectiveness in delivery of value-add services at physician point of care – education and training, performance reporting, practice assessments and performance improvement management.  Develop and execute set of intervention work plans to drive practice improvement of quality, risk adjustment, clinical outcomes performance (gaps in care, documentation & coding, clinical effectiveness), establish annual performance targets and manage to enterprise goals.  Ability to manage coding team for quality or coding accuracy initiatives to maximize gap closure rates.
  • Conduct practice assessments; develop, recommend and implement interventions at the practice level to improve clinical quality, efficiency, clinical effectiveness and satisfaction outcomes. Collaborate with practices to facilitate redesign efforts, support care teams, introduce population health management and support achievement towards improved financial, process and clinical outcomes. Develop and execute set of intervention work plans to drive practice performance improvements, including workflow design and redesign, electronic health record (EHR) optimization, clinical documentation, assessments, and financial performance improvement and reporting. Actively participate in cross-functional teams to conduct work and resolve root-cause enterprise and regional provider underperformance issues.
  • Partner across the organization to plan, develop and execute high-impact, industry compliant (i.e., NCQA, CMS, NYSDOH) provider quality and risk stratification incentive and education programs for Medicare STARs, Medicaid and Exchange Quality Rating System (QRS) that result in improved quality scores, outcomes and satisfaction.  Includes:  program design & alignment, budgeting, target setting, marketing/communication, provider rollout/training, progress measurement, evaluation and reporting out on trends, outcomes, and financial ROI.  
  • Lead and develop team members to drive change across multiple physician practice offices; define team objectives and measure performance to goal.  Build and manage Provider Practice team, empowering their success and growth through coaching and development.  Establish foundational relationships with key provider group leadership and enterprise leaders across stakeholder departments to influence roadmaps and empower team to advance their work. 
     

Job Requirements

Qualifications:

  • Bachelor’s Degree, preferably in a business, clinical, or related field (R)
  • Master’s Degree in Public Health, Healthcare Administration or Business Administration (R)
  • 10+ years related work experience in population health, provider practice administration, electronic medical record technologies/platforms, provider practice transformation and/or provider performance improvement and management. (R)
  • Proven experience in building and leading effective teams; 5-8 years of managerial experience, with demonstrated ability to work in a matrix management environment (R)
  • Ability to travel to offices in New York and Connecticut and across the enterprise (R)
  • Account/vendor management experience (R)
  • Proven ability to handle multiple projects simultaneously in a fast-paced environment and adjust to changes quickly while meeting deadlines (R)
  • Excellent organizational, oral and written communication and interpersonal skills (R)
  • Strong problem-solving skills and effective decision-making skills (R)
  • Ability to collaborate cross functionally and to challenge the status quo as required (R)
  • Comfortable with analyzing data, identifying trends, calculating impact and synthesizing data into actionable information (R)
  • Proficient with Microsoft Office (word processing, database/spreadsheet, presentation) (R)
  • Familiarity with business intelligence and data visualization tools (i.e., Qlikview, Tableu) (P)
  • Certified Professional Coder or Certified Risk Adjustment Coder Certified (P)

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Director, Enterprise QM Provider Engagement Apply now