Population Health and VBC Program Manager

POSITION SUMMARY

The Population Health and Value-Based Care Manager is responsible for developing and implementing strategies to optimize health outcomes for diverse populations served by Adelante Healthcare. This role includes overseeing population health initiatives, managing value-based care programs, and ensuring compliance with relevant healthcare regulations.  This position will be responsible for coordinating with the patient care teams and operational management as well as monitoring and driving the program's financial performance. The incumbent of this position must understand the balance between finances and patient care and be capable of prioritizing accordingly. Additionally, the manager will cultivate partnerships with health plans to support value-based care models.

EXPECTATIONS

Every Adelante Healthcare leader will strive to maximize the performance and contribution of each team member of Adelante Healthcare and the community that we serve every day.   Leaders are expected to set clear performance expectations, establish specific measurable goals for team members to drive accountability and success, provide ongoing feedback and coaching to enhance performance, improve results and outcomes.  Leaders are also expected to work in a manner that demonstrates a commitment to our mission, vision, core values quality, patient safety, employee engagement, innovation, and model for all other employees the highest standards of personal integrity, professionalism, and competence.

OUR CORE VALUES

- I nclusion

- N urture

- S ervice

- P urposeful

- I ntegrity

- R esilient

- E ngaged

Qualifications

ESSENTIAL SKILLS AND EXPERIENCE:

- An associate’s degree in applied sciences or equivalent

- Minimum of three (3) years of experience in population health management, value-based care, or healthcare administration, ideally within an FQHC or similar setting.

- High level of experience with HEDIS, UDS, AZARA, network portals, Care Gaps closure, Data analysis, attestation forms, and performance improvement.

- In-depth understanding of population health principles, value-based care models, and quality improvement processes.

- Strong analytical skills with experience in data analysis and healthcare data management systems.

- Proven ability to build partnerships with health plans and understand value-based care agreements.

- Strong leadership, communication, and interpersonal skills with the ability to collaborate effectively with diverse teams.

- Proficient in healthcare quality improvement methodologies and community health assessment frameworks.

- Good working knowledge of Microsoft Office applications including Outlook, Word, and Excel.

- Must possess excellent verbal and written communication skills, with the ability to communicate effectively with internal and external customers.

- Valid Level One Fingerprint Clearance Card issued by the Arizona Department of Public Safety.

- Certification to perform cardiopulmonary Resuscitation for the Health Care Professional (CPR) and AED through courses that follow the guidelines from the American Heart Association and Red Cross (cognitive and skills evaluations).

- Valid Arizona Driver’s License

- Travel to all health centers if required.

POSITION REPONSIBILITIES/ESSENTIAL:

Compliance with Regulatory Standards:

- Collaborate with Provider Network Manager to ensure Adherence with Networks contracted with Adelante.

- Ensure Adherence with The National Committee for Quality Assurance to improve the quality of healthcare.

- Ensure adherence to HRSA (Health Resources and Services Administration) guidelines related to population health and value-based care initiatives.

- Implement and maintain practices that comply with Arizona Department of Health regulations and Joint Commission standards .

- Ensure Population Health & Health Centers working on VBC conduct regular evaluations and audits to verify compliance, identify areas for improvement, and document progress on quality initiatives .

Education and Training:

- Schedule training for health centers’ key stakeholders to ensure proper use of codes and closure of care gaps.

- Provide training and support to staff on population health management practices, value-based care principles, and relevant data analysis tools.

- Facilitate workshops and learning sessions aimed at enhancing organizational understanding of population health initiatives and their impact on patient care.

Collaborative Efforts:

- Foster strong relationships with healthcare providers, community organizations, health plans, and stakeholders to promote integrated healthcare solutions.

- Participate in community health initiatives aimed at improving access to care, addressing social determinants of health, and enhancing community well-being.

POPULATION HEALTH PROGRAM

- Develop, implement, and monitor population health management strategies that address specific health needs within the community, particularly for high-risk and underserved populations.

- Conduct data analysis to identify health disparities and target interventions for specific populations aimed at improving health outcomes and access to care.

- Design and implement programs to promote preventive care, chronic disease management, and early intervention strategies.

- Collaborate with healthcare providers and community organizations to align resources and services to support population health initiatives.

- Pull data of metrics and benchmarks to evaluate the effectiveness of population health programs, adjust strategies based on performance data, and report outcomes to stakeholders.

- Compile and report outcomes to stakeholders, including success of initiatives, provide insights into program adjustments, and illustrate the impact on community health.

VBC PROGRAM

Financial Tracking and Analysis:

- Collaborate with the Senior Manager of Nursing Department and Medical Areas or Operations Manager to develop and manage financial models to assess the financial viability of value-based care initiatives and track the financial performance of each plan.

- Partner with Operational Value Based Care teammates to optimize efforts for closing care gaps in Medicaid, Medicare, and Commercial patient populations, in that order of priority.

- Partner with Data Analytics department, IT, Clinical and Operational Leadership to maintain accurate patient rosters for the value-based care programs.

- Collect and communicate Value-Based Care quality results and strategies as needed to Senior Manager of Nursing Department and Quality Improvement.

- Prepare and manage budgets for value-based care programs and monitor adherence to financial targets.

- Develop key performance indicators (KPIs) to measure the financial performance of value-based care programs and partner with operational leadership to achieve results.

- Collaborate with  and Provider Network Manager to Identify financial risks associated with value-based care contracts and develop strategies to mitigate them.

- Work to maximize revenue through effective care coordination, patient engagement, and quality improvement initiatives in coordination with Operational and Clinical Management.

- Utilize data analytics and partner with the Data Analytics Team to assess the financial performance of value-based care programs and identify areas for improvement.

- Educate staff and healthcare providers about the financial aspects of value-based care and how their actions can impact financial outcomes.

- Prepare reports and presentations for internal and external stakeholders.

- Stay current with industry trends and best practices in value-based care and healthcare finance.

- Collaborate with the provider network manager to Implement a clear and rigorous system for segregating VBC payments from the regular FQHC PPS prospective payments. This can involve creating separate accounts or financial codes to track VBC income separately.

- Stay up to date with federal and state regulations of FQHC funding and reporting requirements, ensuring that VBC payments do not compromise the FQHC's compliance and remain separate from PPS.

- Collaborate with the provider network manager to generate detailed financial reports that clearly distinguish VBC payments from prospective payments to maintain transparency in financial reporting.

- Collaborate with the Provider Network Manager, CSML in the review process of VBC contracts to understand the terms, conditions, and performance measures associated with these agreements. Ensure that any financial incentives align with the FQHC's mission and goals.

Accountable Care Organization Tracking & Analysis:

- Collaborate with the Provider Network Manager to build a robust, well-documented system for managing all standard ACO operations, including CMS-mandated reporting, patient and provider communications, payments of claims, and maintenance of compliance.

- Collaborated with Nursing Department and operations to align and collect KPIs data; determine insights and performance-improving actions items based on analysis and tracking of indicator reporting.

- Determine how best to use data and analytics to inform effective strategic decision-making around ACO operations.

- Other projects as requested by the Senior Manager of Nursing Department and Quality Improvement.

VBC HEALTH PLANS AUDIT PROGRAM

- Ensure timely execution of audit requests by developing and implementing a robust, well-documented system for responding to health plan audits.

- Develop improvement plans, if necessary, based on internal tracers, identifying trends, and identifying problematic areas.

- Responsible for overseeing Adelante Healthcare's Health Plans Audit Program.

NONESSENTIAL SKILLS AND EXPERIENCE:

- Bachelor’s degree preferred.

Additional Duties and Responsibilities

- Other duties as requested or assigned.

Patient Centered Medical Home (PCMH) and Integrated Care Team (ICT)

All employees are responsible for promoting and participating in interdisciplinary communication and collaboration to enhance the delivery of quality across the health care system. Employees should maintain an environment which supports and engages patients and co-workers in a caring team-based model to promote wellness and improve health outcomes.

Adherence to Compliance and Code of Conduct

All employees are required to comply with Adelante Healthcare’s written standards, including its Compliance Program and Code of Conduct, policies and procedures and reporting of any conduct that potentially violates Adelante’s legal or compliance requirements. Such compliance will be an element considered as part of the regular performance evaluation.

PHYSICAL DEMANDS AND WORK ENVIRONMENT

The physical demands and work environment characteristics described here are representative of those that must be met by an employee to successfully perform the essential functions of this job.  Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions.

Physical demands: While performing the duties of this job, the employee may be required to sit for long periods of time, is required to stand, walk, use hands to handle or feel objects, tools or controls; reach with hands and arms; climb steps/stairs; balance; stoop, kneel, crouch or crawl; talk or hear; smell; manage stress as it relates to essential job functions.  The employee must frequently lift and/or move up to 25 pounds without assistance and may occasionally be required to lift or move up to 50 pounds with assistance.  Specific vision abilities required by the job include close vision, distance vision, color vision, peripheral vision, depth perception, and the ability to adjust focus.

Work environment:    While performing the duties of this job, the employee is exposed to weather conditions prevalent at the time when traveling to various clinic sites.  The noise level in the work environment is usually moderate. The employee may be subject to health hazards (contagious diseases, blood borne pathogens, etc.) when working in the clinic area.