Population Health Performance Specialist

Job ID: J118919
Company: Highmark Inc
Location: Pittsburgh, PA, United States
Full/Part Time: Full time
Job Type: Regular
Posted at: Mar 19, 2018

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Description

JOB SUMMARY

This  job is directly responsible for outcomes of providers contracted in the Organization's gain/risk share arrangements and is a highly skilled expert in practice transformation to achieve the specific targets set in the individual gain/risk share contracts and is strategically focused on those data gaps that will result in the greatest ROI for the Organization. Further, in a matrix management environment, will be responsible for collaborative work with the other members of the value-based reimbursement team, provider relations, senior markets, analytics, actuary and key internal/external stake holders to provide the most appropriate support for providers with gain/risk share contracts.

ESSENTIAL RESPONSIBILITIES

  • Directly responsible for supporting providers contracted in the Organization's gain/risk share programs, with a goal of maximizing quality and ROI for the Organization.  This includes analyzing performance reports and data to inform decision-making, process, and program implementation, as well as the development of process interventions based on practice-level data, trends and identified opportunities. Inclusive of, but not limited to: Advising primary care practices, physicians, nurses and other clinical staff to assist them on their conversion to value-based care; Dissemination and interpretation of quality and efficiency reports; When relevant, dissemination and support of gap closures for STARS and improved coding for government populations. Identification of process improvement gaps in workflow and development of individualized plans to remedy. Providing educational and training sessions.  Creation and maintenance of relationships with specialists and/or hospital resources for providers employed in multi specialty groups or health systems.
  • For value based contracts addressing government markets, directly responsible for the quality improvement and cost savings outcomes as a result of workflow transformation, superior coding accuracy, and Medicare STARS gap closure to providers based upon each individual gain/risk share contract parameters. This includes analysis and interpretation of claims submission for superior coding accuracy, cost and utilization reports, medical loss ratio reports, Medicare STARS gaps and other risk revenue opportunities.
  • Function as the Organization's key contact on gain/risk share multi-disciplinary team. This includes presentation of program results to both internal and external audiences, including practice and entity meetings with the value-based reimbursement multi-disciplinary team
  • Participates in the development and presentation of instructional materials for internal and external audiences.
  • Provides feedback to and collaborates with the analytics team to ensure reports are accurate, and provide meaningful, actionable data. Provide assistance to providers in the use of predictive analytic tools, user interfaces, population health management tools and other data based platforms endorsed by the Organization.
  • Independently and autonomously manage gain/risk share contract caseloads, projects, meetings, deliverables, resources etc. for individualized strategic plans to ensure significant cost savings for provider contract holders using innovative continuous improvement methodologies. This includes cross training in all of Organization’s pay for value and value based reimbursement programs to lend support as needed/defined by market outcomes.
  • Other duties as assigned or requested.

QUALIFICATIONS

Minimum

  • Bachelor's Degree in Business, Finance or Healthcare related field
  • 5 years of experience in practice transformation including population health, ambulatory care setting quality and efficiency metrics, accountable care organization development and support, patient centered medical home, and electronic health records.
  • Experience may be from either health plan or provider employers.

Preferred

  • Familiarity with electronic health records and population health IT solutions
  • Demonstrated experience working with health care data and analytics
  • Experience in Lean, Six Sigma, risk management, contract management, finance management
  • Master's Degree in Business, Finance, or Healthcare related field (can be clinical)

KNOWLEDGE, SKILLS & ABILITIES

  • Must be able to effectively resolve issues and problems across all areas of the corporation, by understanding corporate strategies, policy and scope of authority
  • Because of the broad impact of decisions that are made, must be knowledgeable and sensitive to many internal and external corporate issues
  • Aptitude for a high visibility position demanding integrity, uncompromising professionalism, diplomacy and conflict management
  • Demonstrates a deep understanding of primary care practice operations and workflow across the continuum of variability in primary care and experience in managing provider and administrative leadership relationships
  • Superior written and verbal communication skills and listening skills
  • Ability to adapt engagement strategies to meet market needs

Employee Referral Level - 2

Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities, and prohibit discrimination against all individuals based on their race, color, religion, sex, national origin, sexual orientation/gender identity or any other category protected by applicable federal, state or local law. Highmark Health and its affiliates take affirmative action to employ and advance in employment individuals without regard to race, color, religion, sex, national origin, sexual orientation/gender identity, protected veteran status or disability.
EEO is The Law
Equal Opportunity Employer Minorities/Women/ProtectedVeterans/Disabled/Sexual Orientation/Gender Identity (http://www1.eeoc.gov/employers/upload/eeoc_self_print_poster.pdf)
We endeavor to make this site accessible to any and all users. If you would like to contact us regarding the accessibility of our website or need assistance completing the application process, please contact number below.
For accommodation requests, please call HR Services at 844-242-HR4U or visit HR Services Online at HRServices@highmarkhealth.org

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