Job Code/Title: A6010/ Program Manager, Value Based Care
OPEN UNTIL FILLED
UNM Medical Group, Inc. (UNMMG) is the practice plan organization for physicians and other medical providers associated with the UNM Health Sciences Center. UNM Medical Group, Inc. is a New Mexico non-profit corporation and is an equal opportunity employer. UNMMG offers a competitive salary and an attractive benefit package which includes medical, dental, vision, and life insurance as well as tuition assistance, paid leave and 403b retirement for benefits eligible employees.
Responsible for supporting implementation of Population Health Quality Initiatives for Value Based Care within the Health System. Assists in operationalizing Value Based contracts, including Medicare Fee-for-Service, Medicare Advantage, Medicaid Managed Care, and commercial lines of business. Identifies opportunities for improvement on STAR initiatives, to include HEDIS, NCQA compliance and CAHPS surveys.
The following statements are intended to describe, in broad terms, the general functions and responsibility levels characteristic of positions assigned to this classification. They should not be viewed as an exhaustive list of the specific duties and prerequisites applicable to individual positions that have been so classified.
Responsible for supporting implementation of Population Health Quality initiatives for Value Based Care within the Health System. Assists in operationalizing Value Based contracts, including Medicare Fee-for-Service, Medicare Advantage, Medicaid Managed Care, and commercial lines of business. Identifies opportunities for improvement on STAR initiatives, to include HEDIS, NCQA compliance and CAHPS surveys. Works collaboratively across the UNM Health System with provider groups, clinic managers, analytics, and IT to ensure implementation, education, training and compliance. Supports Director, Health System Population Health, and Value Based Care in managerial oversight of Administrative and UNM Team Health staff and initiatives.
Duties and Responsibilities
- Implements and provides ongoing support of the CMS Quality Rating System.
- Analyze supplemental data reporting for value based care.
- Works with payor and provider teams to ensure quality performance targets are met annually.
- Meets with Patient Centered Medical Home (PCMH) Unit Directors to review quality outcomes, performance, and opportunities for improvement.
- Manages Value Based quality scores annually and develops improvement programs to achieve targets.
- Supports Director, Health System Population Health, Value-Based Care to develop and implement strategies related to Value-Based Quality Improvement, HEDIS, STARS, VBC and P4P Programs as well as assessing the Health System’s quality and performance,.
- Analyzes and trends clinical and provider performance data to develop strategies and interventions to meet contractual value-based targets, including HEDIS, STARS, and P4P Program performance.
- Provides reporting and training to PCMH staff to close gaps in care and facilitate value based care patient outreach efforts.
- Develops and maintains monthly performance dashboards.
- Facilitates, tracks and reconciles flow of contractually required data and documentation to managed care organizations, from PCMH sites, that demonstrates compliance for VBC contracting.
- Works collaboratively with IT, data analysts, and other clinical users to support the design, development, evaluation, validation and implementation of data analysis tools to track, monitor, and report outcomes and progress toward goals.
- Provides managerial support to UNM Team Health staff and initiatives.
- Performs other related duties and responsibilities as required or assigned.
Minimum Job Requirements
Bachelor’s Degree in a relevant field, with five (5) years ambulatory experience preferable in a large medical group, or healthcare system. Preference given to candidates with population health management, value based care, quality measures, and process improvement experience. Verification of education and licensure will be required if selected for hire.
Knowledge, Skills and Abilities Required
Knowledge of Medicare and Medicaid Federal Quality programs
Knowledge of HEDIS, STARS, VBC, P4P, HCC and RAF
Knowledge of applicable federal laws and regulations related to VBC.
Ability to work with clinic informatics and EHR technology, clinical documentation, and auditing tools.
Ability to effectively communicate with physicians and their staff.
Knowledge in the development of policy and procedure documentation.
Ability to analyze, interpret, and draw inferences from research findings, and prepare reports.
Ability to communicate effectively, both orally and in writing with all levels of the organization.
Conditions of Employment
Must be employment eligible as verified by the U.S. Dept. of Health and Human Services Office of Inspector General (OIG) and the Government Services Administration (GSA).
Must pass a pre-employment criminal background check.
Fingerprinting, and subsequent clearance, is required.
Must provide proof of varicella & MMR immunity or obtain vaccinations within 90 days of employment.
Must obtain annual influenza vaccination.
If this position is assigned to a clinical area, successful candidate will be required to complete a pre-placement medical evaluation/health screen. Required N-95 mask fitting, testing, vaccinations to include annual TST, Tdap, and Hepatitis B will be determined based on location and nature of position.
Working Conditions and Physical Effort
Work is performed in an interior medical/clinical environment.
No or very limited exposure to physical risk.
No or very limited physical effort required.