VP Population Health (Health Plan Clinical Operations)
Posted on Jan 17, 2019 by DuPage Medical Group
The employer is one of the largest and most successful independent multi-specialty physician groups.
- Provides organizational leadership and oversight of population health tools, workflow design, outcomes metrics and financial and quality performance
- Provides direct operational oversight and programmatic direction of company clinical operations, including oversight of directors/managers responsible for Utilization Management, Care Coordination (CCM, CM, DM) and Quality
- Requires significant collaboration with internal stakeholders and clients
- Develops and implements a Population Health program that delivers clients and their members results to support the quadruple aim for all value based programs.
- Develops department and team goals and metrics in alignment with organization-wide goals. Gives input to and implements organization-wide initiatives. Collaborates with client clinical leaders to ensure alignment with population health management goals.
- Establishes key performance indicators for various functions within the organization, consistent with industry benchmarks, with the objective of improving quality and reducing the cost of care for client members.
- Promotes positive relationships between organization and clients and serves as liaison between organization and clients regarding matters of population health program.
- Participates in, and, where appropriate, leads, medical cost initiatives and network development strategies as part of the management team.
- Conducts themselves in a manner which promotes equality and service excellence for clients, members, physicians, staff, and visitors; and contributes to the spirit of teamwork.
- Maintains expert status in managed care and population health program development.
- Working with Medical Directors and client leadership, this leader will develop and manage programs and activities related to medical cost management and improvement of clinical quality by assuring appropriate health care delivery for client members.
- Develops and executes strategic direction for achievement of outcomes for managing at risk populations.
- Responsible for the operations of the population health management program, including employing rigorous process improvement techniques resulting in improved execution, better service delivery, and increased cost efficiencies while ensuring high quality.
- Develops standards and continuous improvement initiatives for population health by utilizing best practices.
- Budgets staffing plans and works closely with management team to assure the adequate allocation of resources to population health operational functions in the context of the organization's priorities and strategic plan.
- Monitors in conjunctions with client Medical Directors, availability, appropriateness, and necessity of care rendered by participating providers and by out-of-plan providers.
- Leads the development, implementation, and monitoring of all population health programs, as well as assessing and implementing innovative programs required by the business.
- Ensures standardized execution of medical management programs while optimizing workflow tools and processes to support these activities.
- Manages key health and wellness vendors.
- Facilitate the implementation of value based contracts and any related policies and procedures. Establishes audit controls to assure appropriateness and relevance to payor, NCQA, federal and state regulatory guidelines and requirements. Ensures compliance with regulatory and contractual requirements related to care coordination
- Collaborates with health analytics in its support of aggregation of internal and external data and patient level risk stratification and in establishing capabilities to report performance as required by payers and partner health plans.
- Supports IT in refinement of population health management system such as "alerts" for patient outreach and care coordination, including transition care management and home based care.
- Supports effective business relationships with external entities, including clients, payers and health plan partners on the basis of continuous focus on performance improvement related to population level cost, clinical quality and patient experience goals
- Evaluates the performance of direct reports, including performance to identified standards and metrics and ensures that performance evaluations are conducted for care coordination team members.
- Manages a strong functional team through effective recruiting, training, coaching, discipline, team building and succession planning to achieve a high level of staff satisfaction and performance.
- Leads, manages and mentors staff/teams and project management staff, to support organizational and client goals.
- Bachelor's or Master's degree in a clinical or healthcare related field is required.
- Master's degree in business administration or health administration preferred.
- Current clinical licensure as an RN is preferred.
- CCM preferred.
- Minimum of 7 years' experience in managed care; Health Plan/MSO clinical operations (including Care Management, Utilization Management, and health analytics/reporting) is required.
- Prior experience with care integration across the continuum, especially for high risk, high need sub-population is required.
- Minimum of five (5) years senior leadership experience is required.
- Medicare Advantage experience preferred.
- Experience with Milliman Care Guidelines is required.
- Knowledge of NCQA and Medicare regulatory requirements.
- Knowledge of information systems and healthcare applications.
- Proven leadership skills and high degree of professional initiative.
- Excellent verbal and written communication skills, problem identification and resolution skills.
- Strong financial, analytical and operational skills critical for advancing effective and efficient care integration across the continuum, especially for high risk, high need sub-populations.
- Proven abilities to collaborate with departmental staff, multiple internal and external stakeholders, reconcile priorities and interests, while building alliances based on integrity, follow-through on commitments and delivery of results.
- Proficiency in the use of Microsoft Office applications; Word, Excel, Power Point and Outlook or the ability to learn and apply new technologies and skills.
- Organizes, prioritizes, and coordinates multiple activities and tasks.
- Works effectively in a team environment.
- Works with initiative, energy and effectiveness in a fast-paced environment.
- Able to skillfully navigate change management.
- Excellent presentation, analytical, organizational and interpersonal skills
Adtalem Global Education
Adtalem Global Education
Adtalem Global Education