Population Health Transformation Lead

Description

Position Summary

The Population Health Transformation Lead will develop and implement population health strategies with provider groups currently partnered with Healthmap and its Kidney Health Management (KHM) program, including, but not limited to, Primary Care Physicians (PCPs), Nephrologists, Cardiologists, Endocrinologists, Hospitals and Health Systems, Emergency Departments, etc. to achieve targeted clinical and financial outcomes for managed members via our health plan clients.

Responsibilities  

• Create and assist with the creation of tailored strategies to improve clinical and cost of care performance
  
• Analyze and monitor population health performance across several parameters (e.g., medical expense, risk adjustment, medication utilization and adherence, physician visit utilization, compliance with evidence-based guidelines, Inpatient and Emergency Department Utilization) in partnership with Data Sciences and Medical Economics teams
  
• Educate both internal staff and provider groups to drive appropriate action and closure of identified care gap opportunities
  
• Collaborate with provider-facing teams to ensure that provider office communications are effective and efficient
  
• Maintain current knowledge of evidence-based guidelines for a kidney disease population (e.g., medications, labs, referrals) and coding guidelines and relevant federal and international regulations including but not limited to the current application of: International Classification of Diseases (ICD-10 CM), Current Procedural Terminology (CPT), Health Common Procedure Coding System (HCPCS), Hierarchical Condition Categories (HCC), etc.
  
• Perform other duties as assigned

Requirements 

• Bachelor’s degree in nursing, healthcare administration, business, public health or related field or equivalent experience. Master’s in healthcare administration or public health preferred
  
• At least 5 years of provider/medical operations experience in value-based care setting with risk adjustment coding experience, and Value Based Care methodologies to improve clinical and cost of care performance
  
• Coding certification required through AHIMA or AAPC (at least one of below): Certified Professional Coder (CPC), Certified Risk Adjustment Coder (CRC), Certified Coding Specialist for Providers (CCS-P), or Registered Health Information Management Technician (RHIT)
  
• Prior experiences teaching/training others on correct coding guidelines and other evidence-based guidelines to drive clinical and cost of care performance and have the ability to present to large groups of Physicians/Providers

Skills  

• Strong computer and analytical skills (i.e., MS Word, Excel, PowerPoint) and ability to convey updated business requirements to advance Reporting metrics
• Must be a strong public speaker with excellent written and verbal communication skills and experience effectively delivering subject matter expertise to a large audience of providers and internal staff.
• Ability to manage concurrent projects by understanding and reporting on key program performance metrics and ability to prioritize value levers based on expected clinical/financial impact
• Ability to work with multidisciplinary teams and provide support to other Operational Leaders on initiative delivery and implementations
• Ability to articulate business requirements to Business Intelligence and Data Science teams and analyze data trending to propose tailored strategies to specific provider groups

Travel

Limited Travel, scheduled per needs of the business   

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