Employment Type : Full-Time
Let’s do great things, together 01. Lead the Population Health, Quality, and Value-based care teams. 02. Responsible for all strategy and operations in these areas, and accountable for all related metrics. 03. Partner with Sales and Account Services team to deliver programs and materials that align with sales strategy. 04. Responsible for the department’s budget and resource allocation. 05. Oversee hiring, training, orientation, performance appraisal, scheduling, and corrective action for staff. 06. Provide leadership for the development, implementation and evaluation of population health initiatives designed to keep members healthy, manage emerging member health risk and assist members with managing chronic conditions. This includes managing current programs and creating new innovative and member/client-focused solutions. 07. Engage with and lead working relationships with key delivery system partners and purchasers involved in value-based care networks, contracts, and products. 08. Manage accountability for value based operational performance metrics including quality, financial, triple AIM metrics, and translate these into actionable items based on provider or group specifics. 09. Direct development of actionable financial, quality, and operational data to ensure action plans are implemented to achieve Population Health and Value Based Care performance goals and to meet performance guarantees for purchasers. 10. Lead shared governance models with value-based care delivery system partners and other relevant stakeholders. 11. Collaborate with internal stakeholders to create effective information and analyses to optimize population health, quality, and value-based care performance and strategic objectives. 12. Develop and implement processes for data collection and exchange with delivery system partners and purchasers involved in value-based care arrangements. 13. Be the defined point of contact for providers and employers related to communication for quality, population health, and value-based care performance. 14. Contribute to the development and evaluation of current and future value-based care payment and clinical models. 15. Prepare and deliver presentations for employer meetings and provider meetings with respect to VBC topics. 16. Assures clinical and non-clinical compliance with governing bodies where applicable. 17. Maintains client and patient confidentiality consistent with HIPAA requirements. 18. Leads councils and committees related to Population Health, Quality, and Value-based care. 19. Facilitates identification, adoption, implementation, and utilization of “best practice” clinical practice guidelines and engagement protocols for management of specific diseases/conditions. 20. Identify populations of members/patients who would benefit from participating in a chronic disease management/population health or quality improvement program. 21. Identify, collect, interpret, and evaluate measurable outcomes of care within established time frames (i.e., quality of services, cost and cost savings, ER and hospital utilization, disease management and improvement). 22. Familiarity with social determinants of health and experience in building tools, processes, and partnerships, to positively impact these metrics and outcomes. 23. Serves as a strategic partner to all other Moda departments to coordinate projects, ensuring team, department and company goals are consistently achieved in relation to Population Health, Quality, and Value-based Care. 24. Oversees vendor relationships and outsourced functions specific to lifestyle and wellness, including identification of opportunities, contracting, and monitoring vendor performance, including engagement and outcomes. 25. Ensures regulatory compliance through investigation of best practices, policies and procedures, reports, presentations, and other deliverables, as needed. 26. Assist the Chief Medical Officer and/or Medical Directors as needed. 27. Write, edit, review, and maintain RFP, RFA, and RFI responses related to areas of responsibility. 28. Perform other duties as assigned
Founded in Oregon in 1955, Moda is proud to be a company of real people committed to quality. Today, like then, we’re focused on building a better future for healthcare. That starts by offering outstanding coverage to our members, compassionate support to our community and comprehensive benefits to our employees. It keeps going by connecting with neighbors to create healthy spaces and places, together.
This person leads creation and development of presentations to support provider engagement in shared governance model; and works directly with employers and providers to support meetings, agendas, action plans, and presentations. This person is also expected to attend a significant portion of employer, and provider engagement meetings, including some related to provider governance.
This includes development of working relationships as the single point of contact for providers and employers for these areas. Critical to this work is the development and implementation of processes for data collection and exchange with delivery system partners and purchasers; and then leading Moda’s effective interpretation of data for actionable recommendations to employers and providers to achieve population health, quality, and value-based care performance goals.
This role also will lead additional related areas, for example clinical Innovation, clinical Programs and services, clinical vendors, and liaise with technology teams to assess and implement tools that will help achieve overall goals.
Primary Functions:
Together, we can be more. We can be better.
Moda Health seeks to allow equal employment opportunities for all qualified persons without regard to race, religion, color, age, sex, sexual orientation, national origin, marital status, disability, veteran status or any other status protected by law.
01. Master’s degree or equivalent in a healthcare subject. 5 to 10 years’ experience working in a clinical capacity preferably at a Health Plan. 02. Extensive experience directly leading large teams and working in a matrixed team environment with evidence demonstrating strong relationship building skills.03. Experience leading teams that have been responsible for overall performance in Population Health. Experience in Quality and Value-based care preferred.04. Demonstrates strong proficiency in wide variety of Microsoft applications, presentation creation software, database, reporting, and analytics software, as well as specialized population health, quality, and VBC tools.05. Expertise in and experience of using data analysis tools (e.g. SAS, SPSS) and relational database management. 06. Must be technologically savvy and be able to drive the implementation of new technologies and tools internally and externally amongst the provider delivery network.07. Familiarity with state regulatory and NCQA accreditation standards and process; familiarity with business process redesign principles.08. Ability to be self-directed and work independently with little supervision.09. Ability to work well under pressure, multi-task and track complex projects, and solve complex problems.10. Demonstrates outstanding communication skills – written and verbal, internal and external11. Demonstrates strong organizational skills and ability to organize and prioritize to meet established deadlines.12. Strong facilitation skills with the ability to run provider meetings with a prioritized topic agenda.13. Strong financial background, including the ability to interpret financial statements.14. Strong background working with and improving clinical quality metrics, as well as other health plan quality metrics. 15. Demonstrated a deep understanding of care delivery and quality improvement and has a successful track record of improving quality of care and delivering triple aim goals.16. Demonstrated understanding of provider reimbursement and alternative payment models. 17. Presents a positive and professional image internally, with providers, and more broadly in the communities we serve.18. Ability to maintain strict confidentiality and adhere to all healthcare laws and regulations.19. Ability to assist with external sales calls to present population health initiatives, including goals and results.