Practice Performance Manager

Location

Baton Rouge, LA | United States

Job description

Position Summary:

Equality Health is an Arizona-based population healthcare company focused on improving care delivery for under served populations through culturally-sensitive programs that improve access, quality, and patient trust. Our mission is to ensure diverse populations receive quality healthcare that improves and enriches their lives. We have developed our product portfolio around centralized technology, services and network designs intended to organize a better healthcare delivery system for cultures that have struggle with integrating into the traditional one-size-fits-all U.S. healthcare system.

The Practice Performance Manager I (PPM I) serves as the lead in establishing and supporting a collaborative, innovation-focused relationship with participating practice groups. The goal of this relationship is to optimize practice performance in a value-based and/or risk-based environment and assess against industry standards. This individual will collaborate internally with the Equality Health (EQH) Network Development, Credentialing, Clinical Care, Behavioral Health, and Cultural Care teams, as well as with the Technology Platform. Externally, this individual will work with payer representatives and community partners.

Responsibilities:

• Lead and manage small and mid-size provider group practices, with up to 50,000 members in assigned service delivery area (SDA).
• Train and educate practices in practice transformation activities as outlined in EQH PPM and Practice Transformation Playbook.
• Ensure alignment of practice operations with the key elements of EQH’s Care Model.
• Maximize population health outcomes, member experience, and provider satisfaction through implementation of EQH’s Practice Transformation Playbook, Pillars of Care, adoption of CareEmpower®, EHR integration and interoperability innovations.
• Influence behavioral changes in practice operations in alignment with industry best practices and key EQH practice transformation modules and resources.
• Facilitate Cultural Care, HEDIS, STARS, and RAF training, as well as practice improvement and performance monitoring.
• Determine and utilize a regular meeting cadence with assigned practices to ensure progress on practice transformation and improvement activities, as evaluated by improvement in ECIP earnings, as well as HEDIS and STARs metrics and other contract goals and value-based activities.
• Establish and drive improvement plans measured by cost, quality outcomes and provider satisfaction.
• Support activities to achieve the overall strategy and objectives of the Practice Transformation department and ensure contractual requirements are met at a practical level.
• Serve as the primary point of contact for all other Equality Health subject matter experts that need to interface with the practice and its staff and engage EQH subject matter experts as needed to support practice improvement.
• Develop and strengthen relationships with various provider groups and use influence and leadership competencies to help transform the practice toward value-based care.
• Assume ownership of the post-recruitment phase of practice cycle and responsibility for project leadership to achieve successful completion, integration, or implementation of:
  • Onboarding
  • Practice assessment, measurement, and tiering
  • Performance Improvement and Practice Transformation Playbook, sharing, interpreting, and actioning data reports and scorecards.
  • Education and training
  • Strategic network communication
  • Implementation of EQH product innovations/technology
  • Integration of other EQH teams as appropriate
  • Assess referrals and workflow and support providers in practice transformation.
• Utilize professional, clinical and/or quality improvement experience and expertise to guide the practice in transformation.
• Deliver operational reports (scorecards) to the practice/providers and utilize data analysis techniques to convey opportunities for remediation and influence needed practice changes.
• Identify operational workflows needing remediation and/or support and present solutions; elevate to EQH leadership collaborators and Executive team as needed to resolve issues.
• Perform other responsibilities as assigned for special projects and escalated issues.
• Responsible for accurate documentation and maintenance of provider and practice information.
• Travel throughout the market service delivery area (SDA), up to 90%, via personal automobile; occasional overnight stays may be required.

Required Knowledge, Education, & Experience:

• Bachelor’s degree in business, healthcare administration, or a related field of study; or an equivalent combination of education and/or experience
• A minimum of three (3) years of experience in the healthcare industry, preferably with healthcare network operations and/or practice management
• Demonstrated understanding of risk and value-based contracting
• Strong provider relations skills and experience
• Excellent verbal, written and interpersonal communication skills
• Highly collaborative team approach to work
• Proficiency with Microsoft Office applications and web-based technologies

Highly Preferred Skills, Abilities, & Qualifications:

• Familiarity with payment alternatives such as fee for service, capitation, global budget, performance compensation and episode of care payment
• Knowledge of patient and practice risk adjustment mechanics and premium-based payment methodologies
• Familiarity with patient and practice risk adjustment mechanics, APR; HCC/RAF
• Experience working with conventional payment methodologies (CMS-RBRVS)
• Experience with database management in a healthcare setting
• Demonstrated ability to gain acceptance and compliance from providers and staff to achieve a mutually beneficial outcome.
• Excellent problem-solving skills, including the ability to systematically analyze problems, draw relevant conclusions and devise appropriate courses of action
• Ability to convey complex or technical information in a manner that others can understand, and ability to understand and interpret complex information from others.
• Successful record of managing multiple projects with demonstrated ability to work independently in rapidly changing environments.

Equality Health provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state, or local laws.

This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation, and training.

Job tags

Salary