Program Manager of Risk Capture
Location
Somerville, MA | United States
Job description
About Us
As a not-for-profit organization, Mass General Brigham is committed to supporting patient care, research, teaching, and service to the community by leading innovation across our system. Founded by Brigham and Women's Hospital and Massachusetts General Hospital, Mass General Brigham supports a complete continuum of care including community and specialty hospitals, a managed care organization, a physician network, community health centers, home care, and other health-related entities. Several of our hospitals are teaching affiliates of Harvard Medical School, and our system is a national leader in biomedical research.
We're focused on a people-first culture for our system's patients and our professional family. That's why we provide our employees with more ways to achieve their potential. Mass General Brigham is committed to aligning our employees' personal aspirations with projects that match their capabilities and creating a culture that empowers our managers to become trusted mentors. We support each member of our team to own their personal development-and we recognize success at every step.
Our employees use the Mass General Brigham values to govern decisions, actions, and behaviors. These values guide how we get our work done: Patients, Affordability, Accountability & Service Commitment, Decisiveness, Innovation & Thoughtful Risk; and how we treat each other: Diversity & Inclusion, Integrity & Respect, Learning, Continuous Improvement & Personal Growth, Teamwork & Collaboration.
General Overview The Population Health Management (PHM) department at Mass General Brigham aims to deliver healthcare for all by translating the evolving needs of the healthcare landscape into innovative solutions to better serve individuals, communities, and organizations.
In the healthcare industry, we are in a time like no other. Experts estimate that healthcare will evolve more in the next few years than it has in the last 50 years. We have seen governments, employers, and families struggle in the face of rising healthcare costs and a fragmented healthcare system. Patients and communities need more convenient, more affordable, and higher quality care.
We are building a team that can reimagine healthcare and design care models that meet the needs of the people we serve. We are bringing a fresh perspective and a unique approach to create impact for the greater good. By bringing together people from various disciplines and ideas from different industries, we're seeking to address the complex challenges within our healthcare system and leaning forward into a new era of healthcare.
Under the direction of Population Health Management leadership, with a matrix relationship to MGB Health Plan Director of Risk Management, the Director of Risk Capture will provide administrative oversight, operational management, analytic and other leadership support for activities identified as key to success in our value-based care contracts.
The Program Manager in Risk Capture will lead efforts to support our system's transition to Value Based Care. This position will be responsible for implementing and leading clinical and administrative initiatives focused on helping providers and care teams accurately identify and document conditions of our patients to better understand their care needs. By knowing our patients better, we can connect them to the resources and care they need. This position reports to the Director of Risk Capture and works closely with the Medical Director of Risk Capture. This person will be responsible for overseeing the launch of new interventions intended to help accurate diagnosis reconciliation and HCC (hierarchical condition category) risk capture across Mass General Brigham. This person will have oversight to team members.
Principal Duties and Responsibilities Lead oversight of program initiative
• Provide leadership and management oversight of programs and staff, creating project roadmaps and strategy for the overall Risk Capture program in coordination with administrative and clinical leadership, PHM management, and Regional Service Organization (RSO) stakeholder
• Partner with Medical Director on program strategy and operation
• Participate in, and accept ownership for, cross-department initiative
• Anticipate, identify, and drive resolution of program challenges to prevent downstream problem
• Oversee and delegate as appropriate project related deliverables including project plans, PowerPoint presentations, status reports, meeting minutes, issue/risk logs, and meeting facilitation document
• Independently develop material and communicate updates, findings, and recommendations to internal program steering committees, network committees and audiences outside of Population Health
• Contribute relevant information to leadership for budget development
Build and encourage strong team culture through effective leadership
• Provide leadership and oversight in a way that promotes a supportive, respectful environment that includes training, appropriate delegation, accountability, and growth opportunitie
• Lead hiring and on-going performance management of direct reports and continuously work to develop talent, helping staff meet both their aspirational goals and the organization's needs, providing opportunities for coaching, feedback, exposure and stretch assignments to encourage employee engagement
• Promote continuous improvement within the team
Use data and analytics to drive decision making
• Develop methodologies for evaluating and tracking the success of interventions and quality improvement initiatives, completing quantitative and qualitative analysis to support program objectives.
• Complete quantitative and qualitative analysis to support the objectives of assigned projects.
• Interpret and summarize data using charts, graphics and text to ensure key findings are appropriately communicated in presentations and other methods.
• Maintain a working knowledge of HCCs, evidence-based guidelines, national trends and developments in value-based care and population health, as well as other best practices. Occasionally present at external venues.
Foster collaborative relationships with customers and stakeholder
• Develop effective relationships within PHM, and with clinical and administrative leaders across the MBG entities including but not limited to Revenue Cycle Operations, Professional Billing Office, Compliance, and eCare.
• Collaborate with administrative, clinical leaders and other key stakeholders to support population health management programs and performance improvement initiatives, understanding structured and unstructured data to determine insights and implement evidence-based interventions across stakeholder groups.
• Present ideas, updates, findings, reports, recommendations, data, and analysis to various central and local audiences to build consensus on program initiatives.
• Use Mass General Brigham healthcare values to govern decisions, actions, and behavior
• These values govern how we get our work done: Patients, Affordability, Accountability & Service Commitment, Decisiveness, Innovation & Thoughtful Risk; and how we treat each other: Diversity & Inclusion, Integrity & Respect, Learning, Continuous Improvement & Personal Growth, Teamwork & Collaboration
• Other duties as assigned
#LI-Hybrid Qualifications Qualifications Required
• Bachelor's degree with 5+ years' experience in Risk Adjustment, Managed Care or Healthcare Administration (A combination of education and experience may be substituted for requirements).
• Strong organizational and project management/operations responsibilities experience required, preferably in a healthcare setting.
• Proficient with MS Office Suite.
Preferred
• Familiarity of Risk Adjustment in Value Based Contracts and experience with engaging and guiding provider networks in accurately capturing patient complexity to optimize contract performance.
• Experience in process improvement activities preferred.
• Experience leading staff.
• A combination of education and experience may be substituted for requirements.
• Experience with ICD-10-CM coding
Skills, Abilities Competencies • Demonstrated achievement in leading teams with diverse functions and areas of expertise.
• Strong interpersonal and team building skills. Ability to get work done through others, even if there is no direct reporting relationship.
• Flexible and adaptable within a complex, multi-site environment with changing requirements when the big picture is not always clearly defined.
• Commitment to high quality service and attention to detail.
• Ability to operate with significant autonomy and discretion but know when to escalate potential problems to Leadership.
• A hybrid work model, with at least two days on-site a month; professional office setting located in Assembly Row, Somerville, MA. Requires travel locally to other Mass General Brigham sites. Reliable access to transportation to travel between sites for business purposes is required.
EEO Statement Mass General Brigham is an Equal Opportunity Employer. By embracing diverse skills, perspectives, and ideas, we choose to lead. All qualified applicants will receive consideration for employment without regard to race, color, religious creed, national origin, sex, age, gender identity, disability, sexual orientation, military service, genetic information, and/or other status protected under the law. We will ensure that all individuals with a disability are provided a reasonable accommodation to participate in the job application or interview process, perform essential job functions, and receive other benefits and privileges of employment.
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