Clinical Quality Manager - Population Health - Medicare Advantage (MA)

Bon Secours Health System; United States; Remote; USD 80,000 - 100,000; Full time

Job summary

A prominent healthcare organization is seeking a Clinical Quality Manager to oversee population health initiatives in a remote capacity. The ideal candidate will have extensive experience in healthcare leadership, data analysis, and project management. Responsibilities include leading quality projects and enhancing contractual performance metrics. An RN license and a BSN are required; an MSN is preferred. This is an opportunity to contribute significantly to value-based care.

Benefits

Competitive pay

Medical, dental, vision coverage

Paid time off

Tuition assistance

Qualifications

• Current RN License in the state of work or covered by compact is required.
• Experience in managed security service provider and NCQA is required.
• 7 years of business/healthcare experience in leadership and project management.

Responsibilities

• Lead system-wide population health projects and initiatives focusing on quality outcomes.
• Provide expertise on value-based quality measures to improve contract performance.
• Develop and implement strategic plans for Population Health Clinical Quality.

Skills

Leadership

Data analysis

Project management

Communication

Strategic planning

Education

BSN or Bachelor's in Healthcare or related field

MSN or Masters in Business or Healthcare Administration

Tools

Epic EHR

Excel

Tableau

Job description

Thank you for considering a career at Bon Secours Mercy Health!

Scheduled Weekly Hours: 40

Work Shift: Days (United States of America)

Overview

The Clinical Quality Team is a centralized Population Health team dedicated to ministry-wide support of our value based contracts and gap closure work.

This focus for this Population Health Clinical Quality Manager will be the Medicare Advantage (MA) Value-Based Care (VBID) model.

Primary Function/General Purpose of Position

The Manager of Population Health Clinical Quality is responsible for planning, directing, executing and managing system-wide projects and initiatives to support quality performance across BSMH’s value-based care programs. This role supports growth of population health lives through initiates focused on outreach, gap closure, and care across the patient continuum. The Manager will use clinical expertise to provide leadership, oversight, and coordination for various clinical integration quality activities. This role is vital in providing direction for the implementation of programs that optimize workflows and enhance performance through provider engagement, patient outreach, EHR reporting/tools, and data analysis.

***This is a remote/work at home position. Hire must be open to working eastern time zone hours.

Essential Job Functions

• Leads system-wide population health projects and initiatives: identifying appropriate interventions and strategic solutions, leading change management planning efforts on assigned projects with the initiative owner(s), developing implementation plans and operational workflows, communication with stakeholders and executive leadership, anticipating change management needs, and plans for mitigating barriers.

• Provides subject matter expertise regarding value-based quality measures to system-level leaders, including enhancing value-based contract performance with the identification and validation of clinically relevant data.

• Leads the overall development, implementation, and delivery of the Population Health Clinical Quality strategic plan, including support of additional value-based lives, strategic growth, and identification of gaps cross the continuum of care, while maintaining alignment with the overall ministry goals.

• Directs and leads a team of Population Health Coordinators in defined workflows to support quality outcomes and performance within BSMH’s value-based care programs. Offers direction and guidance to team members while providing education on quality metric specifications, EHR workflows, payer requirements, and data analysis/reporting.

• Develops and implements innovative processes and programs to optimize workflows and enhance quality outcomes through provider engagement, patient outreach, EHR workflows/reporting, and data analysis.

• Represents BSMH by actively participating in payer operations meetings, including Joint Operations Committees, with responsibility for providing updates on value-based contract quality outcomes and maintaining comprehensive understanding of contract requirements.

• Actively engages and represents Population Health Quality in various ACO/CIN Board Meetings and Quality Committees by providing regular presentations on the status of value-based quality processes and outcomes.

• Maintains operational oversight and accountability for Population Health patient outreach activities including affiliate provider partnerships and vendor management. Maintains processes that are aligned with BSMH privacy and compliance policies and procedures.

• Creates and maintains various data tracking tools and visualization platforms to support value-based program quality performance, support change initiatives, and engage stakeholders system-wide.

This document is not an exhaustive list of all responsibilities, skills, duties, requirements, or working conditions associated with the job. Employees may be required to perform other job-related duties as required by their supervisor, subject to reasonable accommodation.

Licensing/Certification

• Current RN License in the state in which they are working or covered by compact(required)

• Certified Professional in Healthcare Quality (CPHQ) (preferred)

• Project Management Professional (PMP) (preferred)

• Lean Six Sigma (preferred)

Education

BSN or Bachelors, Healthcare or related field (required)

MSN or Masters, Business, Healthcare Administration or related field (preferred)

Work Experience

• 7 years of business/healthcare experience in leadership, healthcare quality, and project management with proven career progressions.

• Experience in managed security service provider (MSSP), National Committee for Quality Assurance (NCQA), Centers for Medicare & Medicaid Services (CMS), Healthcare Effectiveness Data and Information Set (HEDIS) (required)

• 10 years\' experience in business/healthcare leadership, healthcare quality, and project management with proven career progressions (preferred)

• Familiarity with Bon Secours Mercy Health systems and processes (preferred)

Training

EPIC (preferred)

Skills

Display adequate proficiency in computer systems, including Excel, Outlook, Word, and PowerPoint.

Ability to manipulate, interpret, and visualize large sets of data in Excel, Tableau, etc.

Expert knowledge of Electronic Health Records (EHRs), preferably Epic.

Ability to differentiate clinically relevant information in general reporting.

Ability to interpret HEDIS technical specifications.

Ability to lead and develop team members.

Critically evaluate clinical data for relevance to associated outcome criteria.

Effectively manage multiple electronic platforms (such as Excel, Epic, payer integration platforms, portals).

Prioritize multiple tasks based upon clinical relevance and outcome optimization.

Lead workflows for teams to manage payer panel of patients and all associated data, trends, and information.

Manage large volumes of data with precise detail.

Lead large team to support demonstration of outcomes through data collection, monitoring and validation processes.

Critically think and be responsible for actionable decisions.

Follow directions with specific detail.

Recognize clinically significant situations and escalate when clinically appropriate.

Ability to quickly pivot based upon value-based contract needs.

Ability to simultaneously lead multiple programs.

Focus on metrics and data-driven solutions.

Active Listening

Process Improvement

Business Strategy

Organizational Leadership

Strategic Planning

Data Interpretation

Critical Thinking

Teamwork

Attention to detail

Time management

Root cause identification

Executive-level communication skills

Executive presence and relationship building

Problem Solving

Self-motivated

engaging patients in care quality measures related to value-based care contracts.

leading teams

supporting the continuum of care

integrating technological solutions and processes needed to meet the population and patient needs

Bon Secours Mercy Health is an equal opportunity employer.

As a Bon Secours Mercy Health associate, you’re part of a Mission that matters. We support your well-being – personally and professionally. Our benefits are built to grow with you and meet your unique needs, every step of the way.

What we offer

• Competitive pay, incentives, referral bonuses and 403(b) with employer contributions (when eligible)
• Medical, dental, vision, prescription coverage, HSA/FSA options, life insurances, mental health resources and discounts
• Paid time off, parental and FMLA leave, shot- and long-term disability, backup care for children and elders
• Tuition assistance, professional development and continuing education support

Benefits may vary based on the market and employment status.

Department: Clinical Transformation/Medical - Population Health Service Organization

It is our policy to abide by all Federal and State laws, as well as, the requirements of 41 CFR 60-1.4(a), 60-300.5(a) and 60-741.5(a). Accordingly, all applicants will receive consideration for employment without regard to race, color, national origin, religion, sex, sexual orientation, gender identity, age, genetic information, or protected veteran status, and will not be discriminated against on the basis of disability. If you’d like to view a copy of the affirmative action plan or policy statement for Mercy Health– Youngstown, Ohio or Bon Secours – Franklin, Virginia; Petersburg, Virginia; and Emporia, Virginia, which are Affirmative Action and Equal Opportunity Employer, please email [e-mail]. If you are an individual with a disability and would like to request a reasonable accommodation as part of the employment selection process, please contact The Talent Acquisition Team at [e-mail].