Summary
The Healthcare Clinical Transformation Manager is responsible for Value Based Care program (VBC) implementation and provider performance management which is tracked by designated provider metrics, and coding accuracy. This person works very closely with the Chief Medical Officer and is responsible for partnering with market leadership to implement and manage the execution and implementation of various programs. These programs include but are not limited to: P4P and Episodes of Care performance, facilitating the shift to in-office surgeries, mental health care, and patient engagement. The Healthcare Clinical Transformation Manager coordinates with the Value-Based Care Team to leverage tools, playbooks and dashboard/metrics developed to educate, track progress on implementation, and to measure performance with their market’s Care Centers. The Clinical Transformation Manager also collaborates with other market leaders to leverage tools and lessons learned and to share insights and available tools with others.
The Healthcare Clinical Transformation Manager will assist with defining quality metrics within episodes to establish meaningful threshold. He/she will work directly with care providers to build relationships, ensure effective education and reporting, proactively identify performance improvement opportunities through analysis and discussion with subject matter experts; and influence provider behavior to achieve needed results. The person will also identify gaps in care through data analysis and chart reviews, and work with care center staff to facilitate coordination of care for patients.
Essential Functions
Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
1. Responsible for education on and implementation of clinical/VBC programs
2. Collaborates with leadership to improve quality of care and patient experience to increase incentive payments and savings.
3. Innovate to link evidence and practice algorithm to improve outcomes and create savings.
4. Works directly with care providers to build relationships, ensure effective education and implementation, proactively identify performance improvement opportunities and influence provider behavior to achieve needed results care for patients.
5. Act as lead to pull necessary internal resources together to provide appropriate, effective provider education, coaching and consultation.
6. Coordinate and lead meetings with provider groups with regular frequency to drive continual process improvement and achieve goals.
7. Establish relationships/liaison with hospitals to partner to implement initiatives and improve quality metrics.
8. Provide reporting to Unified leadership on progress of overall performance, gap closure.
9. Facilitate/lead monthly or quarterly meetings, as required by leader, including report and material preparation.
10. Provide suggestions and feedback.
Qualifications
1. Effective communication and presentation skills.
2. Strong relationship building skills with clinical and non-clinical personnel.
3. Strong knowledge of the market.
4. Strong financial analytical background.
5. Knowledge base of clinical standards of care, and preventive health.
6. Strong critical thinking skills.
7. Microsoft Office specialist with exceptional analytical and data representation expertise; Advanced Excel, Outlook, and PowerPoint skills.
Work Environment
This job operates in a professional office environment.
Physical Demands
The Healthcare Clinical Transformation manager must be able to: use a keyboard and operate computer software and programs; speak, read, write, and communicate clearly and effectively using the English language; make presentations, engage in public speaking, and be able to frequently attend meetings, activities and events during evenings and on weekends as needed; sit, walk, crouch, bend, reach.
Travel will be required to provider offices.
Required Education and Experience
1. Master’s Degree in healthcare field preferred, bachelor’s degree required.
2. 1+ years of healthcare industry experience.
3. 1+ year of customer/patient outreach experience.
4. 1+ year of experience working for a health plan and/or for a provider's office.
5. Experience in leading initiatives/projects.
EEO Statement
It is the policy of LMA Operations to provide equal employment opportunity (EEO) to all persons regardless of age, color, national origin, citizenship status, physical or mental disability, race, religion, creed, gender, sex, sexual orientation, gender identity and/or expression, genetic information, marital status, status with regard to public assistance, veteran status, or any other characteristic protected by federal, state or local law.
Other Duties
Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. Duties, responsibilities, and activities may change at any time with or without notice.
Job Type: Full-time
Benefits:
- 401(k)
- 401(k) matching
- Dental insurance
- Employee assistance program
- Flexible spending account
- Health insurance
- Health savings account
- Life insurance
- Paid time off
- Vision insurance
Schedule:
- 8 hour shift
- Monday to Friday
Supplemental pay types:
Ability to commute/relocate:
- Florham Park, NJ 07932: Reliably commute or planning to relocate before starting work (Required)
Education:
Work Location: One location
