Metro Health Looking for Director at Wyoming, MI Full Time

Director – Ambulatory Quality and Population Health Management * Days – 40hrs/wk.

Shift: Days

General Summary:

Under direction of the University of Michigan Health Partners Executive Leadership and in partnership with the Clinically Integrated Network (CIN) Medical Director and CIN Board of Directors, the Director is accountable for business/operational activities required to drive ambulatory quality performance, excel at the delivery of value-based healthcare, drive performance on value-based healthcare initiatives and achieve superior performance on all population health management programs including but not limited to statewide payer collaboratives, the POM ACO, improved enterprise wide annual wellness visit performance and HCC coding. The director will also partner with UMHP and the Community Clinic to address and record Social Determinants of Health (SDoH) to provide equitable care and outcomes with high community impact/benefit. This role will help sell, support and scale our direct to employer insurance product. The Director will be the administrative support to the CIN Board of Directors and will work diligently to grow our clinically integrated network in partnership with both employed and independent physicians. The Director will lead our journey to managing and accepting risk on various payer lines of business, including commercial, managed Medicaid and Medicare programs. The Director oversees and participates in developing the strategic direction, infrastructure and staffing of the population health management organization (CIN). The Director develops, directs and maintains relationships with third party payer organizations regarding managed care issues including contract negotiation, network adequacy, compliance with managed care contract terms and performance analysis and settlement under various managed care contracts. The Director is responsible for communication and education of the CIN participating members including UMHW hospital, physicians, and other providers.

Requirements:

• Master’s degree required.
• Five (5) or more year’ experience in payor contracting, utilization, quality, financial and clinical information analysis.
• Strong analytic and computer skills, including Access, Excel, and Word.
• Excellent written and verbal communication skills
• Must be a collaborative leader, who can mentor, grow and support all employees within our clinically integrated network.
• Must be familiar and develop deep subject matter expertise with Ambulatory Quality performance metrics, including the development of specialty care quality dashboards.
• Must be a subject matter expert and have expertise in implementing alternative payment models including the assumption of down-side risk with payer programs in all facets of alternative payment models.
• Must have deep subject matter expertise with respect to enterprise wide contracting in partnership with Michigan Medicine contracting team.
• Must have deep subject matter expertise on payer performance programs, including the ability to validate appropriate settlement and performance with various payer collaboratives and programs.
• Be comfortable with selling our direct to employer insurance product to brokers and small to medium sized employers.
• Be comfortable in partnering with our Office of Health Equity to improve ambulatory outcomes for vulnerable and oppressed patient populations.
• Work collaboratively with the Vice President of Quality & Patient Safety on initiatives that impact both hospital and ambulatory care, like ER utilization and transitions of care from hospital back to clinic.

Essential Functions and Responsibilities:

1. Oversee, direct and drive our performance in Ambulatory Quality & Population Health Management Programs.
2. Create and support seamless population health management integration with UMHP, our employed medical group.
3. Achieve best in class HEDIS performance in partnership with engaged physicians within the CIN.
4. In collaboration with the UMHP Office of Health Equity, oversee the identification and analyzation of health equity payer population health patient data in Epic and Healthy Planet across HEDIS measures organization-wide, educating staff to assess and address the SDoH of patient populations. Evaluate performance, reveal trends, identify opportunities and develop action plans to provide equitable care and outcomes to have the most community impact and benefit.
5. Create working group physician leadership structure to work closely with the UMHP Quality and Clinical Outcomes Committee.
6. Engage UMHP on every and all population health management program to ensure alignment to collaboratively drive CIN performance.
7. CIN operations, strategic direction, infrastructure and staffing
8. Act as the primary liaison between UMHP and the CIN, finance/contracting, providing strategic direction and continuity.
9. Execute managed care contracts and programs including the development and ongoing monitoring of a contract strategy for CIN ensuring financial integrity.
10. Establish and maintain relationship with payors, physicians, and purchasers, including contract negotiations and advocacy.
11. Develop and administer policies and directives established by the CIN Board of Directors and provide reports to the CIN Board regarding business activities.
12. Develop and oversee the orientation, training and continued education to staff and physicians regarding contract information, Health Plan, PHO Quality and Clinical Integration initiatives, payor information and pertinent legal information.
13. Ensure the availability of systems for monitoring and ensuring compliance with payor contract terms and conditions and analysis of performance under payor contracts, including utilization, outcomes management, continuous quality improvement, physician and buyer satisfaction and financial reporting.
14. Coordinate network activities to support the Quality and Clinical Integration initiatives adopted by UMHP and the CIN Board of Directors.
15. Develop budget for areas of responsibility and monitor expenditures to ensure efficient and effective utilization of financial resources.
16. Assist with the network development activities including evaluation of access needs of the network and provider practice patterns

Requisition #: req5723

FTE status: 1

On-call: No

Weekends: No