Manager Care Coordination - Population Health Admin

Summary:

Manager Care Coordination is responsible for day-to-day oversight, coordinating, organizing and managing functions and resources for the Population Health, Care Coordination team. This role collaborates and coordinates with Care Management Leadership and colleagues to achieve standardization of assigned functions and responsibilities. This role supports the CHRISTUS Health CIN/ACO, Health Plan, and other initiatives as they arise to ensure care gap closure and quality standards are met.

Responsibilities:

• Meets expectations of the applicable OneCHRISTUS Competencies: Leader of Self, Leader of Others, or Leader of Leaders.
• Develops protocols and procedures to improve staff productivity.
• Collaborates with the Population health care management leadership team to identify key opportunities to help improve quality outcomes and reduce utilization.
• Utilizes systems within the Care Management Department to support an effective and proactive care coordination process across the continuum, working closely with and aligning with care management efforts supporting a patient-centered model that spans the continuum. Collaborates with employed and affiliate providers and staff to ensure seamless patient outreach.
• Directs daily operations to achieve effective utilization of personnel resources consistent with patient and ministry needs to support care gap outreach/abstraction and closure.
• Works closely with and aligns with inpatient CM, Pop Health CM and post acute efforts supporting a patient-centered care management model that spans the continuum.
• Collaborates with inpatient and post-acute providers and staff to ensure seamless transitions of care.
• Assist in the development of annual departmental goals and objectives. Assists in the development of strategic departmental plans and initiatives. Fosters integration and strong collaborative partnerships with quality and health plan payers to identify and support activities to optimize quality outcomes and star ratings (HEDIS/PQA).
• Works in concert with organization colleagues to achieve standardization of operations and efficient operations to ensure processes meet quality/HEDIS standards.
• Understands the financial impact of contracts and changing payment models from fee-for-service to value-based care. Works collaboratively with staff and other key stakeholders to reduce costs.
• Takes initiative to educate self and staff on the changing healthcare landscape including fee-for-service to value-based models, care model innovations, research, and leading evidence-based practices.
• Responsible for managing quality submissions and data integrity for all value-based care ACO arrangements. Including Medicare, Medicare Advantage, Medicaid, Health Exchange, and/or commercial support. Works with EMR & technical teams to ensure efficient workflows & flow of data that impact care gap closure such as payer platform, HEDIS, PQA and STAR ratings and or incentive models, etc.
• Subject matter expert in regulatory requirements for quality submissions such as but not limited to eCQMs/Medicare CQMs, HEDIS, supplemental data files, and HEDIS Roadmaps.
• Partners effectively with the Health Plan to integrate services driving value and efficiency for the company and VBC stakeholders.
• Creates, develops, and provides population health/ACO Education to support CHRISTUS employed or affiliated physician network.
• Must analyze clinical, financial, and social situations, identifying problems and alternative courses of action.
• Demonstrate expertise in value-based care - improving outcomes while managing total cost of care - in a population segment-specific manner.
• Think with an enterprise mindset and continuously challenge the status quo.
• Motivate people and teams while raising performance levels year over year.
• Articulate, persuasive, communicator who is adept at handling executive and difficult audiences well including the ability to adapt style to audience.
• Act independently and offer suggestions and new ideas for improving performance and operations.

Job Requirements:

Education/Skills

• Bachelor's degree required
• Masters in nursing, social work, or healthcare administration preferred

Experience

• 5+ years working with accountable care organization and/or value-based care to support quality and/or performance management of medical costs and quality required
• Demonstrated expertise with Medicare Advantage Star Rating performance & CMS Accountable care
• Experience with MS Office Products - Word, Excel, PPT, and Visio required
• Working experience with Population Health Management technologies and approaches (e.g., high-risk user stratification tools, cost/quality/utilization trend analysis, provider performance tools) required
• Experience supporting value-based care performance and strategy required
• Expertise in Medicare Advantage required
• Strong presentation skills with the ability to present to leadership required
• EPIC EMR experience preferred

Licenses, Registrations, or Certifications

• LVN/LPN preferred

Work Type:

Full Time

EEO is the law - click below for more information:

https://www.eeoc.gov/sites/default/files/2023-06/22-088_EEOC_KnowYourRights6.12ScreenRdr.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 us at (844) 257-6925.