Job Description

We take great strides to ensure our employees have the resources to live well, be healthy, continue learning, develop skills, grow professionally and serve our local communities. We invite you to apply for a career with us.

Residency in or relocation to Louisiana is preferred for all positions.

POSITION PURPOSE

Responsible for assisting Medical Group and affiliate practices to implement best clinical practices with the goal of achieving the quadruple aim-better outcomes, lower costs, improved patient experience, and improved clinician experience. This position is responsible for working with practices to maximize the use of data to facilitate population health strategies to excel in value-based models. Partner with practices to facilitate process and workflow redesign efforts to achieve improved health outcomes. Success will be measured by expected reduction in total cost of care and expected improvements in quality and efficiency metrics.

NATURE AND SCOPE

• This role does not manage people
• This role reports to this job: DIRECTOR, POPULATION HEALTH SERVICES
• Necessary Contacts: In order to effectively fulfill this position, the incumbent must be in contact with:
  
  Physicians, other providers, the practice staff dedicated to population health and their related associates, Medical Group and affiliate practices staff and BCBSLA Health Services Team.

QUALIFICATIONS

Education

• Bachelor's degree from an accredited university in Business, Nursing or a related field is required.
• Education beyond bachelor's degree (e.g. Master of Business Administration, Nursing Degree, Health Administration, etc. is preferred.
• Four years of related experience can be used in lieu of a Bachelor’s degree.

Work Experience

• 5 years of experience in a dynamic, fast-paced healthcare environment is required.
• 2 years of demonstrated experience in analysis of financial and healthcare data which includes all facets of data review, analysis, forecasting, graphics, presenting results and recommendations to management is required.
• In lieu of a Bachelor’s degree, more than 5 years of health care experience in business operations and/or a clinical setting, or a combination of both is preferred.
• Experience working closely with physicians and their administrative staff in a clinical setting is required.
• Experience implementing successful change management processes in organizations is required.
• Experience with creating practice workflows to optimize care delivery, introduce best practices improvements, and evaluate outcomes is preferred.
• Experience can run concurrently.
• Experience with QI change management preferred.

Skills and Abilities

• Thorough knowledge of the ambulatory health care and Patient Centered Medical Home, ACOs or similar population health and quality improvement models of care delivery. Significant experience working with physicians, health care facilities or insurance plans to successfully implement change or train staff may be used in lieu of thorough knowledge of various plan models of care delivery.
• Must be able to represent the company as a population health subject matter expert.
• Excellent presentation, interpersonal and oral and written communication skills are required.
• Requires strong interpersonal, negotiation, sales and relationship building skills along with the ability to persuade others and gain commitments to goals and objectives.
• Must be able to successfully facilitate meetings, committees, seminars, and workshops to achieve established objectives. Course work in Quality Improvement preferred.
• Requires the ability to teach practices how to maximize technology. (EHR’s, registries, decision support tools, web, E-prescribing, and electronic health technology).
• Microsoft Office Software proficiency is required: ability to perform intermediate level functions in Excel, Word, PowerPoint, Outlook, etc.
• Requires excellent critical thinking, problem solving and problem resolution skills.
• Must be able to manage multiple priorities and meet deadlines.
• Requires the ability to work independently, on diverse teams and with internal and external staff at all levels (e.g. management, technical, administrative and support staff, physicians, etc.
• Requires an understanding of the following: the health care industry (including NCQA standards), team- based approach to care delivery, Chronic Care Model, population health interventions and as well as contemporary performance improvement methods (PDCA, LEAN) and basic project management methodology.
• Ability to travel approximately 20% of the time for in-state and out-of-state business is required.

Licenses and Certifications

• None Required

ACCOUNTABILITIES AND ESSENTIAL FUNCTIONS

• Works directly with the Director of Population Health Services and the Clinical data analyst and the provider practice to develop an Annual Plan for Performance Improvement that outlines the priority improvement targets as planned interventions.
• Supports practice staff in the implementation of the Medical Group and affiliate practices’ population health and quality improvement programs and initiatives (recruitment, kick-off meeting, practice orientation, day-to-day support to the practice to help them achieve program goals, etc.). Works directly with Medical Group and affiliate practices providers to represent and to assure the practices have what they need to successfully meet the goals of the Medical Group and affiliate practices program.
• Assists practices in understanding their practice transformation needs to help them achieve their practice goals specific to population health and quality improvement models of care and assists the practices to meet goals and identified targeted standards, data collection needs, and achieve data integration to support Medical Group and affiliate practices’ population health and quality improvement programs and initiatives.
• Creates policy and procedure templates and customized flows for care coordination integration for practices to use to work with the Medical Group and affiliate practices population health and quality improvement programs and initiatives.
• Provides information and resources to practices, change management coaching and practice transformation to help them operate as high performing practices with population health and quality improvement models of care.
• Assists and communicates directly with practices on key components of Medical Group and affiliate practices’ population health and quality improvement programs and initiatives, including, but not limited to their responsibilities and agreements as a Medical Group and affiliate practices program participant, role of the nurse care coordinator, use of data and medical decision support tools and reporting to manage care coordination as well as other expectations and key aspects of participation in the Medical Group and affiliate practices population health and quality improvement programs and initiatives.
• Assures submissions of the practices’ data submissions and/or data integration requirements are clearly communicated to adequately support Medical Group and affiliate practices’ programs and initiatives’ quality and performance measurement process. Provides coaching on improvement issues to participating teams. Assists practice QI teams with understanding, interpreting and implementing their practice transformation plan to achieve program success criteria.
• Oversees the Medical Group and affiliate practices agreements with Medical Group and affiliate practices’ population health and quality improvement program and initiatives to assure that both Medical Group and affiliate practices and provider practices are adhering to their contractual obligations.
• Accountable for complying with all laws and regulations associated with duties and responsibilities.

Additional Accountabilities and Essential Functions

The Physical Demands described here are representative of those that must be met by an employee to successfully perform the Accountabilities and Essential Functions of the job. Reasonable accommodations may be made to enable an individual with disabilities to perform the essential functions

• Perform other job-related duties as assigned, within your scope of responsibilities.
• Job duties are performed in a normal and clean office environment with normal noise levels.
• Work is predominately done while standing or sitting.
• The ability to comprehend, document, calculate, visualize, and analyze are required.

An Equal Opportunity Employer

All internal employees please apply through Workday Careers.

PLEASE USE A WEB BROWSER OTHER THAN INTERNET EXPLORER IF YOU ENCOUNTER ISSUES (CHROME, FIREFOX, SAFARI)

Additional Information

Please be sure to monitor your email frequently for communications you may receive during the recruiting process. Due to the high volume of applications we receive, only those most qualified will be contacted. To monitor the status of your application, please visit the "My Applications" section in the Candidate Home section of your Workday account.

If you are an individual with a disability and require a reasonable accommodation to complete an application, please contact recruiting@bcbsla.com for assistance.

In support of our mission to improve the health and lives of Louisianians, we encourage the good health of its employees and visitors. We want to ensure that our employees have a work environment that will optimize personal health and well-being. Due to the acknowledged hazards from exposure to environmental tobacco smoke, and in order to promote good health, our company properties are smoke and tobacco free.

We perform background and pre-employment drug screening after an offer has been extended and prior to hire for all positions. As part of this process records may be verified and information checked with agencies including but not limited to the Social Security Administration, criminal courts, federal, state, and county repositories of criminal records, Department of Motor Vehicles and credit bureaus. Pursuant with sec 1033 of the Violent Crime Control and Law Enforcement Act of 1994, individuals who have been convicted of a felony crime involving dishonesty or breach of trust are prohibited from working in the insurance industry unless they obtain written consent from their state insurance commissioner.

Additionally, we are a Drug Free Workplace. A pre-employment drug screen will be required and any offer is contingent upon satisfactory drug testing results.