Manager of Nursing Population Health Ambulatory

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POSITION SUMMARY

Reporting to the Vice President Ambulatory Services of the MLK Community Medical Group the Manager of Nursing Population Health Ambulatory is responsible for all ambulatory population health programs including enhanced care management and chronic disease care management. The Manager of Nursing is also responsibility for the quality and performance of the medical group with the Medicare ACO managed care plans and independent practice associations. The Manager of Nursing is an integral member of the ambulatory leadership team and is expected to participate meaningfully in ambulatory activities that support the care center sites including building relationships training of staff and providers regarding performance in quality and achieving organizational and patient outcomes leading to optimization of performance with the payers.

ESSENTIAL DUTIES AND RESPONSIBILITIES

• Lead the care management teams to achieve objectives related to enrollment of participants service provision for enrolled patients addressing barriers to care responding to escalations and advocating
• Conducts performance management through the delivery of provider reports feedback and education and guiding actionable initiatives from data in collaboration with Medical Director.
• Integrates care management risk adjustment annual wellness/care visit and quality initiatives into practice and assist with program engagement.
• Track and report on clinical quality metrics such as HEDIS & NCQA to inform program improvement to meet organizational and regulatory goals.
• Lead the transition of innovative ideas from pilot to implementation and share best practices.
• In collaboration with Director of Nursing leads practice transformation initiatives quality committee health plan/ACO joint operating committees and participates in provider meetings as assigned.
• Evaluates and contributes to managing total medical expense and cost savings initiatives across the enterprise.
• Strong relationship building by identifying go-to providers and other leaders to engage implement and sustain population health and quality improvement programs
• Co-facilitate and/or lead practice manager forums/meetings related to value-based care initiatives
• Provide EMR HealtheIntent and other technology training in the practice related to population health programs and other ambulatory technology platforms.
• Serve as the primary lead for NCQA Population Health Program (PHP) accreditation aligning programs with core standards including data integration population assessment and targeted interventions.
• Support regular HEDIS reporting through validation of data management processes accurate reporting for specified measurement year and meeting deadlines.
• Perform regular gap analyses against NCQA standards to identify areas for improvement and implement evidence-based practices to synchronize care for complex individuals.
• Implement and maintain a written Quality Improvement (QI) plan that includes defined goals performance assessment processes and systematic evaluation of aggregate data and trends.
• Inspires employees to optimize performance and serves as a resource to staff for clinical ethical or systems issues.
• Design and implement user-friendly report templates that facilitate easy data access for leadership and self-service analytics for end users.
• Research and implement evidence-based programs targeting specific chronic diseases (e.g. diabetes) and wellness initiatives.
• Utilize clinical and claims data to identify care gaps high-risk populations and trends. Use risk stratification frameworks to prioritize interventions for high-need patients
• Highly emotionally intelligent and able to manage multiple competing priorities while supporting and working with various stakeholders.
• Responds to internal and external stakeholder inquires and needs in timely manner.
• Other duties as assigned.

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POSITION REQUIREMENTS

A. Education

• Bachelors Degree
• LVN or RN license required

B. Qualifications/Experience

• 3 years of leadership experience in practice management provider relations and project management required
• 2 years of population health/managed care experience managing participating provider performance in quality and utilization.
• Proficient in Microsoft Office products (Excel and PowerPoint)
• Excellent written and oral presentation skills with the ability to engage inspire build credibility and trust
• Highly organized and self-motivated individual with ability to adapt and communicate with multiple levels of staff and leaders in the organization with the ability to work autonomously.
• Collaborative working style with the ability to work across different teams areas of expertise and adapt to ambiguous environments and clientele
• Hypothesis driven to identify trends predict issues highlight critical areas and develop corrective action plans

C. Special Skills/Knowledge

• 3 years experience in practice re-design work including Patient Centered Medical Home Practice Transformation Quality Improvement ACO development Ambulatory Care Quality and Efficiency metrics and EMR
• IPA and/or health plan experience with a provider perspective and strong orientation to value-based care principles and the health policy landscape
• Working knowledge of clinical quality metrics such as RAF HEDIS NCQA or National Quality Forum type metrics
• Experience in data analytics comprehension