Execute EmblemHealth’s value-based physician practice engagement program across all markets to improve quality, health outcomes, access, and experience while managing financial performanceRepresent and advances Emblem’s interests in the provider market as the preferred plan through superior customer service, administrative ease, quality, provider/member satisfaction, risk score improvement, cost efficiency, value based contracting and practice transformation activities. Deliver integrated engagement data, tools, and services at point of care, provides training and feedback, and conducts practice assessments; leads performance management for assigned accounts. Assist providers to adopt company platform to close health care gaps and risk documentation and coding. Align and advance relationships with local and regional partners to drive membership growth.
- Build and sustain collaborative relationships with physician groups and their practice staff to achieve value-based performance goals through provider customer service, engagement and account management activities.
- Conduct routine on-site provider visits, coordinated meetings with key subject matter experts (e.g., quality, risk adjustment, pharmacy and medical management).
- Lead joint quarterly and monthly meetings to review progress and performance opportunities with leadership.
- Improve the provider experience with the plan through focused education and training, performance reporting, effective communication of new products, benefits, policies or initiatives, and resolution of provider issues across the business as the primary contact for the account.
- Drive provider performance and engagement through delivery of routine performance scorecards, reports, and population health data (e.g., attributed membership, physician rosters, medical expense ratio, utilization, quality, and risk coding/documentation).
- Create strategies to improve key performance indicators; analyze performance data and identify opportunities and performance drivers; coordinate with interdisciplinary teams to improve outcomes (e.g., quality, clinical team, pharmacy, risk adjustment, medical economics, and IT).
- Conduct practice assessments and collaborates with physicians and staff to set action plans and goals.
- Work cross organizationally to ensure successful implementation of provider performance programs and agreements.
- Assure provider contractual relationships and obligations are maintained in compliance with regulatory requirements and EmblemHealth policies and procedures.
- Conduct annual contract reviews and amendments for assigned accounts as required to maintain current and accurate measures and benchmarks and targets in accordance with NYSDOH, CMS, NCQA, and other regulatory bodies.
- Deploy and educate provider practices on EmblemHealth self-service population health management and reporting tools, value offerings, and value-based and performance programs; complete ad-hoc projects as assigned/required.