Job Description
Clinical Quality Manager - Population Health - Medicare Shared Savings Program (MSSP)
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At Bon Secours Mercy Health, we are dedicated to continually improving health care quality, safety and cost effectiveness. Our hospitals, care sites and clinicians are recognized for clinical and operational excellence.
Overview
The Clinical Quality Team is a centralized Population Health team dedicated to ministry-wide support of our value based contracts and gap closure work.
This Population Health Clinical Quality Manager will support the Medicare Shared Savings Program (MSSP) value-based care model.
Primary Function/General Purpose Of Position
- The Manager of Population Health Clinical Quality is responsible for planning, directing, executing and managing system-wide projects and initiatives to support quality performance across BSMH’s value-based care programs. This role supports growth of population health lives through initiates focused on outreach, gap closure, and care across the patient continuum.
- This is a remote/work at home position. Hire must be open to working eastern time zone hours.
- Essential Job Functions
- Leads system-wide population health projects and initiatives: identifying appropriate interventions and strategic solutions, leading change management planning efforts on assigned projects with the initiative owner(s), developing implementation plans and operational workflows, communication with stakeholders and executive leadership, anticipating change management needs, and plans for mitigating barriers.
- Provides subject matter expertise regarding value-based quality measures to system-level leaders, including enhancing value-based contract performance with the identification and validation of clinically relevant data.
- Leads the overall development, implementation, and delivery of the Population Health Clinical Quality strategic plan, including support of additional value-based lives, strategic growth, and identification of gaps cross the continuum of care, while maintaining alignment with the overall ministry goals.
- Directs and leads a team of Population Health Coordinators in defined workflows to support quality outcomes and performance within BSMH’s value-based care programs.
- Develops and implements innovative processes and programs to optimize workflows and enhance quality outcomes through provider engagement, patient outreach, EHR workflows/reporting, and data analysis.
- Represents BSMH by actively participating in payer operations meetings, including Joint Operations Committees, with responsibility for providing updates on value-based contract quality outcomes and maintaining comprehensive understanding of contract requirements.
- Actively engages and represents Population Health Quality in various ACO/CIN Board Meetings and Quality Committees by providing regular presentations on the status of value-based quality processes and outcomes.
- Maintains operational oversight and accountability for Population Health patient outreach activities including affiliate provider partnerships and vendor management.
- Creates and maintains various data tracking tools and visualization platforms to support value-based program quality performance, support change initiatives, and engage stakeholders system-wide.
- Licensing/Certification
- Current RN License in the state in which they are working or covered by compact (required)
- Certified Professional in Healthcare Quality (CPHQ) (preferred)
- Project Management Professional (PMP) (preferred)
- Lean Six Sigma (preferred)
Education
BSN or Bachelors, Healthcare or related field (required)
MSN or Masters, Business, Healthcare Administration or related field (preferred)
- Work Experience
- 7 years of business/healthcare experience in leadership, healthcare quality, and project management with proven career progressions.
- Experience in managed security service provider (MSSP), National Committee for Quality Assurance (NCQA), Centers for Medicare & Medicaid Services (CMS), Healthcare Effectiveness Data and Information Set (HEDIS) (required)
- 10 years' experience in business/healthcare leadership, healthcare quality, and project management with proven career progressions (preferred)
- Familiarity with Bon Secours Mercy Health systems and processes (preferred)
Skills
Display adequate proficiency in computer systems, including Excel, Outlook, Word, and PowerPoint.
Ability to manipulate, interpret, and visualize large sets of data in Excel, Tableau, etc.
Expert knowledge of Electronic Health Records (EHRs), preferably Epic.
Ability to differentiate clinically relevant information in general reporting.
All applicants will receive consideration for employment without regard to race, color, national origin, religion, sex, sexual orientation, gender identity, age, genetic information, or protected veteran status, and will not be discriminated against on the basis of disability.
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