Data management, analysis, reporting and performance measurements related to quality initiatives and value based payor managed care contracts and designated governmental entities.
Overseeing the activities of medical home recognition.
Monitoring and help coordinate the efforts of practice sites to ensure the successful implementation of NCQA PCMH roll-out to clinic locations.
Will function as a Technical Lead in PCMH activities and assigned managed care and valued based contract initiatives.
Project management of the yearly GPRO initiatives, which includes coordinating the auditing staff, training and roll out of the project to the clinicians, managers and ministries.
Management of the Bridges to Excellence Program (BTE) which includes monitoring the quarterly submission and timely upload of the data files generated by the IT Analytics team. Providing administrative support to designated clinical and administrative leadership to facilitate the successful achievement of the TMF quality initiatives and pay for performance objectives with contracted managed care payors
Customer Service Standards
Responsible for data management, comprehensive analysis, reporting and serves as a distribution resource for all Medical Home related payor quality and value based initiatives: 1.Information / Data gathering and integration 2.Data base management 3.Internal / External data information management 4.Analysis, reports, projects, presentations 5.Distribution
Serves as Technical Lead for medical home certification, process and activities. Assist with clinical activities including evaluation clinic activities for certification readiness. Performance of audits, training, education and NCQA PCMH preparedness.
Provides the oversite for the Bridges to Excellence data files created by our IT Data Analytics Team. Duties include: timely of Provider and clinical data files for all Chronic Illnesses being measured. Files are required quarterly.
Ensures the successful implementation of the yearly GPRO submission for CMS. Duties include recruiting auditors, training, auditing of internal and external ACO membership participants.
Ensures payer value based contract compliance and timelines are achieved with data submission, retrieval, quality measurement, activity performance and other stated performance measurement deliverables. Provides TMF / Payor reconciliation of care coordination payments, quality measurement and pay for performance measurement and payments.
Collaborates and provides support to Chief of Primary care and Chief Quality of Quality to ensure successful implementation and achievement of TMF performance objectives for quality performance and value based payor contracts.
Assists and supports the Chief of Primary Care, designated clinical / administrative leadership with planning, development and implementation of process improvement strategies and action plans to ensure successful achievement of payor value based quality performance metrics and pay for performance targets.
Provides Chief of Primary Care and designated clinical / administrative leadership support for assigned Trinity Clinic Medical Home initiatives and pilot projects.
Provides administrative support to Chief of Primary Care and designated clinical / administrative leadership to organize and facilitate quarterly â€œBest Practiceâ€� performance improvement meetings with primary Care Physicians and midlevel providers, management and staff.
Strictly adheres to Managed Care Payor communication protocols.
Documents all internal and external customer account activity in assigned contract management software.
Performs other duties and projects as assigned.
Bachelorâ€™s degree in Business, Computer Science, Communications or other relevant areas.
Advanced Microsoft applications: especially Excel, Access and Power Point. Must be able to present data in meaningful method, i.e. charts, graphs, etc.
Electronic Medical Record experience.
5 years of functional operating experience within a physicianâ€™s clinic / hospital or health plan setting.
Extensive knowledge of HEDIS quality measures.
Comprehensive knowledge of medical billing coding procedures and medical terminology
Comprehensive knowledge and understanding of database management and relational database software.
Working knowledge of spreadsheet data manipulation.
Working knowledge and ability to provide accurate and detailed data analysis.
Ability to analyze problems and identify solutions.
Knowledge of JCAHO, Six Sigma and / or Lean background.
Leading clinics in NCQA PCMH preparedness.
Provides the leadership skills, training, organization of the yearly GPRO initiative.
Monitors and provides oversight for the quarterly rollout of the Bridges to Excellence Chronic Illness Quality Payment Program.
Provides leadership to peers and colleagues regarding data management, quality initiatives, process improvement, the importance of evidence based medicine and operational support.
CHRISTUS HEALTH is an international Catholic, faith-based, not-for-profit health system comprised of almost more than 600 services and facilities, including more than 60 hospitals and long-term care facilities, 350 clinics and outpatient centers, and dozens of other health ministries and ventures. CHRISTUS operates in 6 U.S. states, Colombia, Chile and 6 states in Mexico. To support our health care ministry, CHRISTUS Health employs approximately 45,000 Associates and has more than 15,000 physicians on medical staffs who provide care and support for patients. CHRISTUS Health is listed among the top ten largest Catholic health systems in the United States.