Company Statement

For the last 80 years, EmblemHealth has been taking care of New York’s heart and soul, its people. Today, health care is more complex than ever. That’s why we’re at the forefront of change. We work alongside our customers to offer access to high-quality, affordable care, help navigate the health care experience, and make good health achievable; because everyone deserves to be taken care of. We deliver on our mission every day by living our values with our colleagues, members, clients and partners. It begins with caring and respecting all those we work with. We believe a culture of diversity and inclusion is vital to serve our unique and diverse customers. We seek for continues improvement and innovation and believe being agile and nimble is our advantage. We bring a strong sense of partnership to every relationship – internally and externally. The EmblemHealth family of companies offers competitive health, welfare, and retirement benefits as well as incentive pay plans and more.

Director, Enterprise QM Provider Engagement

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Director and Equivalent
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EmblemHealth
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Develop enterprise provider network and practice-level physician engagement strategy, infrastructure, model and accompanying tools to drive success. Working directly with key provider partners, facilitate population health management and member growth capabilities through practice transformation activities. Develop cross-organizational high-impact provider incentive and education programs to drive quality, risk stratification, and clinical effectiveness improvement; execute across enterprise provider network. Lead a high-value team of Physician Practice Engagement Associates to achieve optimized Quality, Stars, Risk Adjustment (Coding Accuracy), Clinical Outcomes Performance, and CAHPS ratings. Collaborate with Quality Management, Medical Management, Finance, Product, Pharmacy, IT, Sales business leaders to align strategies and provider performance improvement priorities.

Responsibilities:

  • Design and implement physician practice engagement model, infrastructure and accompanying tools (i.e., program offerings, business intelligence and data visualization tools, checklists and scorecards) for Physician Practice Engagement team effectiveness in delivery of value-add services at physician point of care – education and training, performance reporting, practice assessments and performance improvement management.  Develop and execute set of intervention work plans to drive practice improvement of quality, risk adjustment, clinical outcomes performance (gaps in care, documentation & coding, clinical effectiveness), establish annual performance targets and manage to enterprise goals.  Ability to manage coding team for quality or coding accuracy initiatives to maximize gap closure rates.
  • Conduct practice assessments; develop, recommend and implement interventions at the practice level to improve clinical quality, efficiency, clinical effectiveness and satisfaction outcomes. Collaborate with practices to facilitate redesign efforts, support care teams, introduce population health management and support achievement towards improved financial, process and clinical outcomes. Develop and execute set of intervention work plans to drive practice performance improvements, including workflow design and redesign, electronic health record (EHR) optimization, clinical documentation, assessments, and financial performance improvement and reporting. Actively participate in cross-functional teams to conduct work and resolve root-cause enterprise and regional provider underperformance issues.
  • Partner across the organization to plan, develop and execute high-impact, industry compliant (i.e., NCQA, CMS, NYSDOH) provider quality and risk stratification incentive and education programs for Medicare STARs, Medicaid and Exchange Quality Rating System (QRS) that result in improved quality scores, outcomes and satisfaction.  Includes:  program design & alignment, budgeting, target setting, marketing/communication, provider rollout/training, progress measurement, evaluation and reporting out on trends, outcomes, and financial ROI.  
  • Lead and develop team members to drive change across multiple physician practice offices; define team objectives and measure performance to goal.  Build and manage Provider Practice team, empowering their success and growth through coaching and development.  Establish foundational relationships with key provider group leadership and enterprise leaders across stakeholder departments to influence roadmaps and empower team to advance their work. 
     

Qualifications:

  • Bachelor’s Degree, preferably in a business, clinical, or related field (R)
  • Master’s Degree in Public Health, Healthcare Administration or Business Administration (R)
  • 10+ years related work experience in population health, provider practice administration, electronic medical record technologies/platforms, provider practice transformation and/or provider performance improvement and management. (R)
  • Proven experience in building and leading effective teams; 5-8 years of managerial experience, with demonstrated ability to work in a matrix management environment (R)
  • Ability to travel to offices in New York and Connecticut and across the enterprise (R)
  • Account/vendor management experience (R)
  • Proven ability to handle multiple projects simultaneously in a fast-paced environment and adjust to changes quickly while meeting deadlines (R)
  • Excellent organizational, oral and written communication and interpersonal skills (R)
  • Strong problem-solving skills and effective decision-making skills (R)
  • Ability to collaborate cross functionally and to challenge the status quo as required (R)
  • Comfortable with analyzing data, identifying trends, calculating impact and synthesizing data into actionable information (R)
  • Proficient with Microsoft Office (word processing, database/spreadsheet, presentation) (R)
  • Familiarity with business intelligence and data visualization tools (i.e., Qlikview, Tableu) (P)
  • Certified Professional Coder or Certified Risk Adjustment Coder Certified (P)

EEOC Statement

We are committed to leveraging the diverse backgrounds, perspectives and experiences of our workforce to create opportunities for our people and our business. We are an equal opportunity/affirmative action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, protected veteran status or any other characteristic protected by law.

Sponsorship Statement

Depending on factors such as business unit requirements, the nature of the position, cost and applicable laws and regulations, EmblemHealth may provide work visa sponsorship for certain positions.

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