Resp & Qualifications
This role exists to provide expert practice consulting to the multi-Panel entities (e.g Health System-owned Practices and independent multi-site Primary Care Groups) that exist within the 20 Regions of the CareFirst’s Patient-Centered Medical Home (PCMH) program spanning the greater Baltimore, Washington DC and Northern Virginia service areas. The incumbents would serve as the primary day-to-day liaison between CareFirst and the multi-panel entities. In the ideal state, the Entity Practice Consultant becomes a de facto part of the entity’s management team, attending planning sessions, staff meetings and delivering CxO level reports to the entity’s leadership team on a monthly basis (Entity HealthCheck) providing insight into their overall performance in the Program.
The incumbent ensures that the Practice Consultant teams are conducting actionable analysis and driving behavior change within entities related to referral patterns, reducing gaps in care and quality efforts, engagement in care coordination and the various Total Care and Cost Improvement programs, effectiveness of medication management, etc.
Entity Practice Consultants collaborate with the Managers of PCMH Practice Consulting; the Manager of Specialty Practice Consulting, Regional Care Directors, PCMH Senior Leaders and other stakeholders in effectively monitoring, evaluating, coordinating and communicating the overall effectiveness of the PCMH Program.
Under the general supervision of a Vice President of Practice Consulting, the incumbent’s accountabilities may include, but are not limited to, the following:
1. Day to Day Communication, Relationship Management and Issue Resolution –
Provides the entity with information on enhancements to the PCMH program and important changes to the Program Description & Guidelines.
Troubleshoots or explains data that was questioned and identifies opportunities for alignment between the entity and CareFirst.
Maintains day to day contact with the entity’s leadership and assures that problems don’t fester and practice transformation plans don’t drift off course.
2. Strategic and Tactical Business Planning and Program Performance Improvement
Given that multi-panel entities are engaged in efforts to implement ACOs, MACRA, EHR enhancements and a number of other enterprise-wide initiatives, the Entity Practice Consultant leverages their level of involvement and entity relationships to identify opportunities to align initiatives already in progress with things that would benefit the entity in the PCMH program, thereby accelerating the change PCMH promotes and the results we seek.
Develops and executes the agenda and business plan with the entity leadership (and approved by CareFirst management). Works with the Regional Care Directors and Practice Consultants who have the entity’s Panels in their regions to execute the plan. Acts as the escalation path for RCDs or PCs who are struggling with particular Panels in their regions. Leverages day-to-day relationship with the entity leadership to quickly resolve any problems so that the agreed upon objectives can still be accomplished.
3. Tracking/Monitoring and Reporting of Impact – this includes analyzing and reporting on progress amongst the panels; preparing impact analysis and presentations for senior executives.
Provides briefings on how the entity is doing as a whole, which Panels are contributing or detracting from the entity’s success in the program, the status of key initiatives, as well as the internal politics and personalities to be understood to enable CareFirst Sr. Directors or other executives to participate in periodic meetings with entity leadership. Is involved and embedded with these entities to such a degree that they can deliver such a report on demand without referring to notes.
- Master’s Degree in Public Health , Health Administration, Business Administration, or related field or equivalent
- 2+ years of experience in a practice transformation consulting role, within CareFirst preferred
- A minimum of 2 years’ experience with progressively increasing responsibility in health care environment, health insurance payer environment, or related industry.
- Demonstrated ability to effectively analyze data and develop strategies for quality improvement efforts surrounding the data; partner with PCMH leadership to demonstrate data presentation improvements.
- Exceptional presentation skills and the ability to coach and deliver feedback to less experienced Program Consultants’ presentation skills
- Proven ability to work collaboratively and effectively with others in a large, matrix organization
- Demonstrated leadership skills including the ability to: 1) train, coach and motivate the performance of others; 2) positively impact the performance of close colleagues as a trusted consultant.
- Demonstrated ability to effectively influence and maintain composure with CxO level.
- Must be able to work independently with minimal oversight and demonstrate attention to detail, accuracy and quality awareness.
- Exceptional analytical and problem solving skills.
- Effective written and interpersonal communication skills, well organized, able to multi-task and work independently, promote flexibility and teamwork.
- Able to travel throughout PCMH program area on a daily basis and work in the field the majority of the work week. Must have reliable transportation for travel between corporate offices, provider/panel offices and other locations as needed.
- Advanced computer skills, Microsoft Word, Microsoft Outlook, PowerPoint, and Excel.
- Must be able to effectively work in a fast paced environment with frequently changing priorities, deadlines, and workloads that can be variable for long periods of time. Must be able to meet established deadlines and handle multiple customer service demands from internal and external customers, within set expectations for service excellence. Must be able to effectively communicate and provide positive customer service to every internal and external customer, including customers who may be demanding or otherwise challenging.
PCMH Program Consultants
Equal Employment Opportunity
CareFirst BlueCross BlueShield is an Equal Opportunity (EEO) employer. It is the policy of the Company to provide equal employment opportunities to all qualified applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, protected veteran or disabled status, or genetic information.
Hire Range Disclaimer
Actual salary will be based on relevant job experience and work history.
Where To Apply
Please visit our website to apply:
Please apply before:
Federal Disc/Physical Demand
The incumbent is required to immediately disclose any debarment, exclusion, or other event that makes him/her ineligible to perform work directly or indirectly on Federal health care programs.
The associate is primarily seated while performing the duties of the position. Occasional walking or standing is required. The hands are regularly used to write, type, key and handle or feel small controls and objects. The associate must frequently talk and hear. Weights of up to 25 pounds are occasionally lifted.
Sponsorship in US
Must be eligible to work in the U.S. without Sponsorship