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Description

This role works with matrix partners across the organization to educate and manage provider performance expectations focused on quality measure outcomes, risk improvement and overall performance to financial targets in Health Partner’s value-based programs. Monitors and shares individual and group performance in regular face-to-face meetings using Key Performance Indicators (KPIs). Engages with providers and office staff to build trust and shift the way providers think about value-based care. Shall promote all clinical programs available as a resource to facilitate full engagement and improve outcomes. Shall play a critical role in fortifying the collaborative relationship we seek to establish with our physicians at the practice level.

Minimum Job Qualifications
Educational Requirements: Bachelor's degree in Business, Healthcare, Information Science, or related field

Minimum Experience:
Minimum of 5+ years experience with increasing responsibilities in developing and executing risk coding programs. Knowledge of, and experience with, utilizing EPIC EHR. Knowledge of, and experience with, health plan value-based arrangements, alternative payment models, healthcare risk quality, and population health outcomes. CRC (Certified Risk Coder) certification (Preferred but not required)Job Specific and Unique Knowledge, Skills and Abilities Experience leading program development and management efforts involving provider/partner engagement and implementation. Experience developing and monitoring delivery of efficient and effective solutions to diverse and complex business problems. Demonstrated ability to embrace and utilize technology and other innovative solutions to deliver enhanced processes and results for provider partners. Expertise in creating training materials and delivering user training. Ability to establish strong relationships and maintain a high level of trust and confidence. Exceptional communication skills, internally and externally, with the ability to convey key messages and influence stakeholders and to convey technical concepts in easily understood ways. Strength in problem-solving based on experience, subject matter expertise, and objective data analysis. Comfortable working on simultaneous and diverse projects and activities. Self-directed, ability to execute projects with minimal supervision. Excellent time management skills with a proven ability to meet deadlines. Ability to work under pressure with urgency and speed while maintaining a high degree of accuracy. Ability to communicate comfortably and effectively at all levels of organization to achieve results. Effective use of Microsoft Office software (Outlook, Excel, PowerPoint and Word). Essential Tasks and Responsibilities Shall develop a comprehensive risk coding accuracy program and curriculum in dyad with matrix partners to include leveraging effective efforts underway within the provider groups Leads collaborative efforts to design and create content-specific internal and external risk adjustment training curriculum and programs Shall set priorities for RA staff in a manner that executes on the right set of initiatives to improve risk scores Shall develop and or identify quality, risk score and financial KPIs that reflect each provider’s contribution towards goals for all contracted payer relationships Shall use dashboards and other reporting tools available from EPIC and or the payers to convey performance trends to providers, groups, and leadership Shall partner with providers and clinical/administrative staff to enhance understanding of clinical documentation improvement goals to achieve risk adjustment strategic goals and objectives Coordinate and deliver programs through flexible approaches including onsite, classroom, remote hosted, and self-service web-based models Design, execute, and report on evaluation methods and key performance indicators to measure results, identify risks/barriers to project rollout, timely deliverables, and adoption success Shall work in close partnership with Health Partners’ care management and quality teams to produce relevant material to share with the providers Shall participate in rolling out new programs and services to providers as they are developed Shall travel to Health Partner provider locations to oversee and execute engagement and shall document all visits in a standard format and retain for future reference Shall create organized presentations and other content to present to various committees and the Board Shall demonstrate the ability to be a strong people performance manager with the ability to motivate staff and drive results Ability to analyze project needs and determine resource requirements to meet objectives and solve problems that span multiple interdisciplinary teams and environments Shall build relationships and communicate with external and internal parties to deliver key messages, influence stakeholders, manage expectations, and shape outcomes

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The Medical Director of Accountable Care is the physician executive for accountable care across Stanford Health Care (SHC) and Stanford Medicine Partners (SMP) and provides medical leadership and direction to the clinical teams responsible for accountable care delivery. This enterprise leader develops innovative care models and clinical interventions focused on management of patient populations and provides oversight of provider performance in achieving value-based care. The Medical Director of Accountable Care works closely with Accountable Care, Quality and Operational leaders to define strategic priorities and goals for Accountable Care, and collaborates closely with medical, operational, finance and quality leadership, to achieve desired outcomes. This leader works within a highly matrixed environment to facilitate awareness and alignment with key leaders, physician groups, individual physicians, and external stakeholders. Reports to Associate Chief Medical Officer for Ambulatory Care. Commitment to effort: 100% FTE

EDUCATION QUALIFICATIONS:
Doctorate required. Candidates may be Physician MD or DO

EXPERIENCE QUALIFICATIONS:

1. At least five years of experience in a similar role, with experience as a leader in a large matrixed organization strongly preferred.
2. Strategic thinking and business acumen with the demonstrated ability to align clinical strategies with business objectives.
3. Operational focus with demonstrated data analysis/interpretation acumen, project management, change management, and execution skills.
4. Extensive knowledge of managed healthcare systems, medical quality assurance, quality improvement and risk management.
5. Track record of successful leadership of case management, disease management, and Accountable Care programs.

Email Trina Nand for the full job description!

PURPOSE

The ACO Operations Manager will provide day-to-day oversight to Wilmington Health’s client groups participating in the Accountable Care Organizations associated with Wilmington Health’s Management Services Organization (MSO), Block Ops. This position will facilitate and support program governance, operations and communication strategies for our MSO ACOs which includes the development and maintenance of project plans, quality initiatives, cost containment, and patient experience initiatives.

Essential Duties/Responsibilities

Maintains knowledge regarding ACO policies and procedures, governance structure and regulatory requirements through ongoing research and regular attendance at training webinars. Utilizes standard project management tools and principles to define and manage project scope, monitor timelines and deliverables, and communicate and identify pathways to resolve risks and barriers. Oversees and maintains effective communication with stakeholders using communication plans, status reports, dashboard and various media sources tailored to the audience. Effectively plans and facilitates meetings of varied participants using standard meeting management tools and techniques (e.g. agendas, meeting roles, ground rules, minutes, action item tracking) including support of meeting logistics for ACO Boards and committees. Leads process improvement, new workflow development, enhancement through support of and collaboration with practices to drive performance on contract quality and equity metrics. Works collaboratively with practices and providers to develop campaigns to address gaps in care, monitors patient and practice/provider compliance with campaigns and provide feedback and adjustment as needed to ensure success. Leads planning efforts to enable the Block Ops team to effectively achieve high performance in risk-based contract quality and equity metrics and ensure compliance with regulatory agencies. In collaboration with the WH ACO and analytics teams, develops comprehensive operation for clinical data acquisition, reporting, and workflow development in support of quality measure improvement. In collaboration with local leaders, informs the redesign of local workflows to drive performance in quality and equity metrics. The Compliance Officer will create, maintain, and audit the ACO’s Compliance Plan and provide regular reports to the Governing Body of the ACO. Establish and maintain a method for employees or contractors of the ACO, its ACO Participant Provider and Preferred Providers, and other individuals or entities performing functions or services related to ACO Activities or Marketing Activities to anonymously report suspected problems. Work with the Wilmington Health Compliance Officer to receive claims analysis to identify potential fraudulent behavior or program integrity risks, such as inappropriate reductions in care, effort to manipulate risk score or aligned populations, overutilization, and cost-shifting to other payers or populations. Audit chart, medical records, Implementation Plans and other data from the ACO, its ACO Participant Providers and its Preferred Providers. Cooperate with all CMS monitoring and oversight requests and activities. Ensure compliance with all applicable state licensure requirements regarding risk-bearing entities in each state in which the ACO operates. In a form and manner and by a deadline specified by CMS, the ACO shall submit to CMS documentation demonstrating its compliance with the requirement set forth in the Agreement. Ensure compliance with all plans submitted to CMS for benefit enhancements or waivers. Ensure that the ACO has appropriate procedures in place to ensure that ACO Participant Provider and Preferred Providers have access to the most up-to-date information regarding Beneficiary alignment to the ACO.

QUALIFICATIONS

Required: 3+ years’ experience in healthcare, with value-based care models (CMS MSSP, ACO REACH, Commercial full or partial risk contracts).Demonstrated understanding of healthcare clinic models, HEDIS measures, STAR ratings, documentation processes, and strategies to close gaps in care and support caring for high and rising risk patients with multiple chronic conditions. Strong expertise with MS Excel, MS Teams, and PowerPoint. Preferred: 5+ years’ in healthcare operational management Demonstrated understanding and experience with SQL queries and analytics, understanding of risk stratification models, and the ability to translated data-driven insights into clear clinical priorities and interventions. Bachelor’s Degree in Healthcare or Business Administration.

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The CareNu Senior Accountant is responsible for implementing and maintaining accounting processes and records; performing analysis of source transaction files, data, and documentation; and preparing journal entries, reconciliations, financial statements, and pro forma financial reports.

See job responsibilities, qualifications and more.

IRCCO, a large, statewide, rural ACO is seeking an experienced executive director (ED) to expand its footprint with commercial payers and strengthen its current MSSP readiness for risk in two years. IRCCO has a 5-member coaching team in place and a home office in Princeton, IL. IRCCO is an LLC and is governed by a Board of CEOs elected by its twenty-seven hospitals and one independent practitioner. IRCCO has earned commercial shared savings in multiple years. This is a full- time position that offers a competitive salary, excellent benefits, and bonus potential. IRCCO has a contract with the Illinois Critical Access Hospital Network (ICAHN) for the Princeton office space, fiscal services, ACO staff employment, and IT support. The ED would not be required to live in Princeton but be able to travel to the office and meet with hospital and clinic participants as well as potential contract partners. The ED has overall accountability for the ACO and reports directly to the Board chair. The ACO infrastructure is in place; the position presents an outstanding opportunity for professional growth and state and national leadership presence.
Please email resume to Pat Schou at or you may call Pat, current IRCCO ED, at 815-875-2999.

The Population Health Clinical Pharmacy Technician (PHCPT) assists the value based ambulatory pharmacist and multi-disciplinary population health team in providing services to patients to support performance in our value-based contracts, The PHCPT works cross functionally with others internally and externally to support data driven results. Conducts patient outreach by way of telephone, mychart and other appropriate means to influence successful care gap closure and improved outcomes.

Minimum Job Qualifications

• Licensure or other certifications: Pharmacy Technician Board Certificate registered with the Georgia Board of Pharmacy

Educational Requirements

• Associates Degree

Minimum Experience

• 3 or more years of experience as a pharmacy technician with experience in medication adherence.

Essential Tasks and Responsibilities

• The primary responsibility of this role is to provide support to team pharmacists, clinicians and the care management team to ensure effective, safe, and cost-effective drug therapy for patients that are part of the CIN's value based contracts.
• The Population Health Pharmacy Technician works closely and directly with patients to deliver a full continuum of medication adherence support by utilizing various tools, applications, data and analytics
• Responsible for obtaining medication refill histories, performing comprehensive pharmacy benefits investigations and assisting with provider communications
• Builds rapport with patients to identify strengths and barriers to medication access with the goal of closing the care gap and promoting exceptional patient care
• Develop and build a rapport with pharmacists, providers and clinical staff to provide the highest level of care for patients with complex needs
• Identifying and resolving complex medication-related issues, and ability to know when to involve or escalate to pharmacist, provider or leadership.
• Facilitate the completion of medication reconciliation activities, assist patients overcome barriers to medication adherence, conduct medication outreach, and complete community resource referrals
• Communicate and collaborate with local pharmacies to troubleshoot issues affecting medication adherence or access.
• Provides follow up with pharmacies to verify patients pick up medications, closing care gaps
• Populates data into databases, payer portals, and other data repositories to assess patient activity/medication adherence rates and address barriers to care to improve outcomes
• Review and remedy medication care gap reports and organize daily call list for patient outreaches
• Participates in quality and payer meetings as directed
• Participate in staff meetings, in-services, and other program-specific tasks and activities as require

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The Population Health Clinical Pharmacy Technician (PHCPT) assists the value based ambulatory pharmacist and multi-disciplinary population health team in providing services to patients to support performance in our value-based contracts, The PHCPT works cross functionally with others internally and externally to support data driven results. Conducts patient outreach by way of telephone, mychart and other appropriate means to influence successful care gap closure and improved outcomes.

Minimum Job Qualifications

• Licensure or other certifications: Pharmacy Technician Board Certificate registered with the Georgia Board of Pharmacy

Educational Requirements

• Associates Degree
• Minimum Experience: 3 or more years of experience as a pharmacy technician with experience in medication adherence.

Essential Tasks and Responsibilities

• The primary responsibility of this role is to provide support to team pharmacists, clinicians and the care management team to ensure effective, safe, and cost-effective drug therapy for patients that are part of the CIN's value based contracts.
• The Population Health Pharmacy Technician works closely and directly with patients to deliver a full continuum of medication adherence support by utilizing various tools, applications, data and analytics
• Responsible for obtaining medication refill histories, performing comprehensive pharmacy benefits investigations and assisting with provider communications
• Builds rapport with patients to identify strengths and barriers to medication access with the goal of closing the care gap and promoting exceptional patient care
• Develop and build a rapport with pharmacists, providers and clinical staff to provide the highest level of care for patients with complex needs
• Identifying and resolving complex medication-related issues, and ability to know when to involve or escalate to pharmacist, provider or leadership.
• Facilitate the completion of medication reconciliation activities, assist patients overcome barriers to medication adherence, conduct medication outreach, and complete community resource referrals
• Communicate and collaborate with local pharmacies to troubleshoot issues affecting medication adherence or access.
• Provides follow up with pharmacies to verify patients pick up medications, closing care gaps
• Populates data into databases, payer portals, and other data repositories to assess patient activity/medication adherence rates and address barriers to care to improve outcomes
• Review and remedy medication care gap reports and organize daily call list for patient outreaches
• Participates in quality and payer meetings as directed

Participate in staff meetings, in-services, and other program-specific tasks and activities as require

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Manages a risk coding team responsible to develop a robust curriculum of education and training tools for Health Partners network providers to ensure coding accurately reflects the health status of patients. Works to foster an atmosphere that supports the philosophy of complete and accurate coding and documentation to assure Medicare compliance and optimal data generation. Ensures efficiency, accuracy, and compliance to CMS Policy as it relates to Coding and Documentation for the purposes of Risk Adjustment. Supports existing auditing functions by dyad partners by assisting in the development of appropriate provider queries, policy/procedures, and supports team members with the delivery of coding-focused education to providers. Assists matrix partners in working with provider populations to close Chronic Disease Gaps in Care and other defined program goals. Skilled at yielding results with a strong sense of ownership of the results.

Minimum Job Qualifications

• Licensure or other certifications: CRC (Certified Risk Coder) credential
• Educational Requirements: Bachelor's Degree

Minimum Experience

• 5+ years of related Coding/Auditing work experience.
• Experience supervising risk adjustment staff and deploying RA programs. 3+ years of leadership experience Job Specific and Unique Knowledge,

Skills and Abilities

• Knowledge of CPT, ICD-9, ICD-10, HEDIS, Medicare services and reimbursement methodologies, RBRVS.
• Extensive knowledge of Medicare and CMS Risk Adjustment payment rules, regulations, and guidelines.
• Ability to guide a matrix team to ensure accurate & complete documentation.
• Sharp communication and presentation skills, both written and verbal, with the ability to effectively communicate with people at all levels internally and externally.
• Effective time-management and project management skills, including the ability to thoughtfully plan, interpret complex processes/programs, develop realistic goals/metrics, and resolve and/or escalate issues in a timely fashion and ensure adherence to timelines.
• Solid collaboration, interpersonal, problem-solving and coaching skills.

Essential Tasks and Responsibilities

• Develops, executes, and maintains HCC comprehensive visit review program to ensure proper documentation of diagnoses and validation of diagnoses with feedback to Providers.
• Collaborates with cross-functional teams to develop relevant coding guidance to the provider population consistent with established coding authorities and in compliance with relevant federal guidance.
• Facilitates appropriate modifications to clinical documentation to accurately reflect patient severity of illness and risk through extensive interaction with Health Partners providers, care management and nursing staff, other care givers and the coding staff.
• Maintains knowledge of coding rules and program regulations to ensure the documentation in the patient record accurately reflects all elements impacting the patient risk score thereby contributing to a compliant patient record.
• Reviews data and trends, identifies additional areas of opportunity, communicates findings and recommended solutions, delivers provider-specific metrics and coaches' providers on Gap-closing opportunities as needed.
• Collaborates cross-functionally and assists with the preparation of data and reports to evaluate the effectiveness and overall impact of the clinical documentation improvement program for presentation to appropriate oversight committees.
• Educates members of the patient care team, including medical staff, on documentation guidelines on an on-going basis as needed.
• Identifies and assists in the development and implementation of departmental policies and procedures according to established workflows.
• Moves coding functions from "transactional" to "actionable" to drive accurate results.
• Coordinates with Compliance Department to establish audit processes and responses in assuring provider coding and documentation compliance with Federal and State regulatory bodies.
• Responds to and oversees audit requests.
• Assists with the development, implementation, and oversight of auditing projects including ensuring auditing/coding production satisfies all business needs and contractual requirements.

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This role works with matrix partners across the organization to educate and manage provider performance expectations focused on quality measure outcomes, risk improvement and overall performance to financial targets in Health Partner’s value-based programs. Monitors and shares individual and group performance in regular face-to-face meetings using Key Performance Indicators (KPIs). Engages with providers and office staff to build trust and shift the way providers think about value-based care. Shall promote all clinical programs available as a resource to facilitate full engagement and improve outcomes. Shall play a critical role in fortifying the collaborative relationship we seek to establish with our physicians at the practice level.

Minimum Job Qualifications

• Licensure or other certifications:
• CRC (Certified Risk Coder) certification.

Educational Requirements

• Bachelor's degree in Business, Healthcare, Information Science, or related field

Minimum Experience

• Minimum of 5+ years experience with increasing responsibilities in developing and executing risk coding programs.
• Knowledge of, and experience with, utilizing EPIC EHR.
• Knowledge of, and experience with, health plan value-based arrangements, alternative payment models, healthcare risk quality, and population health outcomes.

Apply Now!