Clinical Quality Manager - Population Health - Medicare Shared Savings Program (MSSP)

Bon Secours Mercy Health; Cincinnati (OH); Remote; USD 85,000 - 110,000; Full time

Job summary

A leading healthcare provider is seeking a Population Health Clinical Quality Manager to oversee projects that improve quality across value-based care programs. This role involves strategic planning, team leadership, and ensuring compliance with healthcare standards. Candidates should possess an RN license and a BSN as well as extensive experience in healthcare quality and project management. Remote position available with a focus on eastern time zone hours.

Benefits

Comprehensive medical, dental, and vision plans

Flexible spending accounts

Paid time off

Qualifications

• Current RN License in the state of work is required.
• 7+ years of healthcare experience with project management.
• Experience with quality measures and data analysis.

Responsibilities

• Lead population health projects and initiatives.
• Provide subject matter expertise on quality measures.
• Direct and guide a team to support quality outcomes.

Skills

Data Interpretation

Project Management

Leadership

Critical Thinking

Microsoft Excel

Teamwork

Process Improvement

Education

BSN or Bachelors in Healthcare or related field

MSN or Masters in Business or Healthcare Administration

Tools

EPIC

Tableau

Job description

At Bon Secours Mercy Health, we are dedicated to continually improving health care quality, safety and cost effectiveness. Our hospitals, care sites and clinicians are recognized for clinical and operational excellence.

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 Population Health Clinical Quality Manager will support the Medicare Shared Savings Program (MSSP) value-based care 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.

Licensing/Certification

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

Benefits

Comprehensive, affordable medical, dental and vision plans

Prescription drug coverage

Flexible spending accounts

Life insurance w/AD&D

Employer contributions to retirement savings plan when eligible

Paid time off

Educational Assistance

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 Employers, 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]