Value-Based Care Consultant - Hybrid - Pittsburgh - FT

West Penn Allegheny Health System; Pittsburgh (Allegheny County); On-site; USD 90,000 - 130,000; Full time

Job summary

Allegheny Health Network in Pittsburgh seeks a seasoned professional to advance clinical integration and value-based reimbursement initiatives across CIN practices, partners, and regional leaders. You will train practices on CIN cost/utilization reports, analyze performance data, and develop action plans to improve patient outcomes while containing costs.

Collaboration with regional teams and councils is essential.

Qualifications

• Bachelor’s degree in health-related field or equivalent experience.
• 5 years of population health management principles or related clinical quality or practice operations experience.
• 1 year of pay-for-value programs/payer contracts experience.
• 1 year of experience with Patient-Centered Medical Home principles PA Registered Nurse license.

Responsibilities

• Provide training to assigned practices to utilize CIN cost/utilization reports and analytics.
• Analyze practice performance data to identify opportunities and develop action plans.
• Foster adoption of optimized workflows and improved HER technology utilization.
• Develop POD-specific goals and report progress to leaders and councils.
• Perform practice capability assessments and prepare comprehensive findings.
• Serve as liaison for care path implementation and care management programs.
• Contribute to regional practice manager education and learning initiatives.

Skills

Population health management

Pay-for-value programs experience

Patient-Centered Medical Home concepts

PA RN license

Education

Bachelor’s degree in health-related field

PA Registered Nurse license

Job description

Company : Allegheny Health Network Job Description :

GENERAL OVERVIEW

This job works collaboratively with participating Clinical Integration Network (CIN) practices and institute stakeholders, regional concierge team and CIN leadership to implement clinical integration and Value-Based Reimbursement (VBR) optimization initiatives by encouraging physicians and care teams to explore the benefits, challenges and opportunities in improving health care outcomes while containing healthcare costs. Develops and implements strategies to promote the principles of value-based, patient-centered care delivery and the goals of the CIN. Serving as a consultant, cultivates in-depth relationships with assigned practices, institutes, and regional partners through in-person meetings and collaboration to set strategic priorities, report results, and identify opportunities for improvement.

ESSENTIAL RESPONSIBILITIES

• Provide training to assigned practices and/or institutes to utilize and understand CIN cost/utilization reports and use of analytics technology. Perform ongoing in-depth analyses of practice performance reports and other data to identify opportunities, develop practice-specific action plans, and implement strategies to achieve CIN VBR goals. (25%)
• Within their assigned CIN region, the incumbent, through a consultative role, provide training and foster adoption of optimized workflows, enhanced panel management techniques, improved HER technology utilization, and education on regional quality cost and utilization opportunities, all designed to improve patient access to high-value care, prevent unnecessary episodes of high-cost care, and improve patient outcomes. (25%)
• Work collaboratively with regional operations team and Local Advisory Council (LAC) leaders to develop POD-specific goals and clinical integration strategies. Prepare LAC presentations and provide progress reports based on regional goals. If applicable within assigned region, actively participate in regional quality councils. (10%)
• Perform practice capability assessments and develop comprehensive analysis of findings. (10%)
• Serve as the liaison for care path implementation and care management programs (ECCM) by facilitating introduction and implementation of these services within the practices. (10%)
• Participate in the development and delivery of regional practice manager educational programs, webinars, learning collaborative and dissemination of best practice workflows and strategies. (10%)
• Actively participate and contribute in regional CIN operations meetings, institute leadership meetings, and corporate team meetings. (10%)
• Other duties as assigned or requested.

QUALIFICATIONS

• Required Bachelor’s degree in health-related field or relevant experience and/or education as determined by the company in lieu of bachelor's degree.
• 5 years of population health management principles or related clinical quality or practice operations experience
• Preferred 1 year of pay for value programs/payer contracts experience.
• 1 year of experience with Patient-Centered Medical Home principles PA Registered Nurse license

Disclaimer

The job description has been designed to indicate the general nature and essential duties and responsibilities of work performed by employees within this job title. It may not contain a comprehensive inventory of all duties, responsibilities, and qualifications required of employees to do this job.

Compliance Requirement

This job adheres to the ethical and legal standards and behavioral expectations as set forth in the code of business conduct and company policies. As a component of job responsibilities, employees may have access to covered information, cardholder data, or other confidential customer information that must be protected at all times. In connection with this, all employees must comply with both the Health Insurance Portability Accountability Act of 1996 (HIPAA) as described in the Notice of Privacy Practices and Privacy Policies and Procedures as well as all data security guidelines established within the Company’s Handbook of Privacy Policies and Practices and Information Security Policy. Furthermore, it is every employee’s responsibility to comply with the company’s Code of Business Conduct. This includes but is not limited to adherence to applicable federal and state laws, rules, and regulations as well as company policies and training requirements.

Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities and prohibit discrimination against all individuals based on any category protected by applicable federal, state, or local law. California Consumer Privacy Act Employees, Contractors, and Applicants Notice Highmark Health is a national, blended health organization that includes one of America’s largest Blue Cross Blue Shield insurers and a growing regional hospital and physician network. Based in Pittsburgh, Pa., Highmark Health’s 35,000 employees serve millions of customers nationwide through the nonprofit organization’s affiliated businesses, which include Highmark Inc., Allegheny Health Network, HM Insurance Group, United Concordia Dental, HM Health Solutions and HM Home & Community Services. Highmark Health’s businesses proudly serve a broad spectrum of health-related needs including health insurance, health care delivery, population health management, dental solutions, reinsurance solutions, and innovative, technology solutions.