Minimum 5 years of relevant experience as a Manager and/or Director in the management of population health-related programs such as health system management
445 Grant Avenue, San Francisco, CA 94108
The Director of Population Health serves as the lead of operations and programmatic development, planning, implementation and delivery of Clinical Programs in CCHP consistent with Population Health and managed Care strategies to lead business units in championing initiatives to achieve desired operational objectives.
The Population Health area will serve as the central hub for programs that drive performance for CCHP on all lines of business.
The Director of Population Health is responsible for developing and implementing various practice improvement and member-centric programs to coordinate delivery of care to defined populations.
ESSENTIAL DUTIES AND RESPONSIBILITIES
- In partnership with senior leadership, serves as a subject matter expert to assist in consistently advancing population health programs and managed care operations focused on quality outcomes and total cost of care.
- Provides routine operational performance updates with escalation of issues and recommendations to leadership as appropriate
- Leads teams and service agreements with adherence to protocols and process regulations to ensure best practices in managed care operations: Quality Improvement, Risk Adjustment, and other departments as required.
- Data and Analytics: Partners with Clinical and IT Analytics teams to define opportunities to optimize program performance.
- Prepares and delivers reports to operational leadership outlining progress toward meeting annual goals and objectives, to include performance related to finance, quality, safety, marketing, and human resources
- Directs corresponding compliance functions consistent with all regulatory standards including but not limited to CMS, NCQA, URAC, DMHC, Covered California.
- Oversees Quality Improvement Initiatives, Perform an evaluation of the QI program that assesses both progress in implementing the QI strategy and the extent to which the strategy is in fact promoting the development of an effective QI program on a regular basis.
- Ensures essential staffing for the following committees and workgroups: QI, Risk Adjustment, Stars, AMP and CovCA QIS and Provider Value-Based evaluations
- Oversees Risk Adjustment Programs, and monitors programs in collaboration with Risk Adjustment Manager.
- Leads internal, Covered CA, and CMS annual Quality Improvement Projects with support of the QI Manager.
- Works with other stake holders on evaluation and compliance of Health Equity requirements.
- Evaluates and monitors quality of services, hospital Patient Safety Indicators and informs providers and members of the results of such evaluation. Submit reports as required to state-federal and regulatory entities. Develops timely and specific actions to correct identified problems and follow-up monitoring to validate corrective action plans and subsequent improvement
- Establishes annual establishing population health outcomes and financial goals by LOB and RBOs and actively uses benchmarking to high performing systems in similar area of expertise to set annual targets
- Applies Lean methodology to projects where appropriate.
- Remains current of new trends and best practices and incorporates into Population Health programs
- Accepts and performs other duties as assigned.
- Bachelor’s degree in a relevant subject area such as Public Health, Nursing, Health Administration, Social Work, Business Administration or Equivalent. Qualifications will be evaluated on an individual basis e.g. Foreign degrees, experience and credentials.
- Minimum 5 years of relevant experience as a Manager and/or Director in the management of population health-related programs such as health system management
- Minimum 5 years of experience working in Health Plan setting.
- Knowledge of population health, quality of care concepts and methodologies, as well as concepts of community health and social determinants of health
- Strong customer service skills. Ability to establish and maintain productive business relationships, manage conflict and negotiate solutions
- Strong leadership and relationship-building skills
- Demonstrated experience implementing practice transformation programs across a variety of provider groups and care team models.
- Excellent organizational
- Demonstrated innovative approach to problem resolution.
- Ability to work collaboratively across UW Health entities and disciplines
- Time management and organizational skills, including the ability to prioritize concurrent projects and activities, meet deadlines and work under time constraints
- California Driver’s license and ability to drive preferred
- Able to lift up to 30 pounds
- Use proper body mechanics when handling equipment
- Standing, walking and moving 50% of the
- Occasional local and non-local travel to company and customer
Complies with CCHP and Chinese Hospital’s Compliance Program including Code of Ethics and all statutes, regulations, guidelines applicable to federal and state programs. Responsibilities include, following the guidelines and reporting suspected violations of any statute, regulations, agreements or guidelines applicable to all healthcare programs.