Director, Population Health - Cheyenne, United States - Blue Cross Blue Shield of Wyoming

Description

Job Description Summary:
The Director of Population Health is responsible for the development, implementation, and oversight of population health programming that translates strategic initiatives into actionable operational plans enabling impactful population health management activities; a position incumbent is accountable for identifying and acting upon opportunities for participation or partnership in external initiatives/activities in alignment with the organizational objectives. Also responsible for maintaining knowledge of current and emerging population health strategies, models of care and related trends, as well as ensuring that all population health related programs meet regulatory and contractual requirements.

Job Description:

JOB SUMMARY

The Director of Population Health is responsible for the development, implementation, and oversight of population health programming that translates strategic initiatives into actionable operational plans enabling impactful population health management activities; a position incumbent is accountable for identifying and acting upon opportunities for participation or partnership in external initiatives/activities in alignment with the organizational objectives. Also responsible for maintaining knowledge of current and emerging population health strategies, models of care and related trends, as well as ensuring that all population health related programs meet regulatory and contractual requirements.

ESSENTIAL DUTIES & RESPONSIBILITIES

Responsible for effectively serving as in the director role by ensuring contemporary knowledge of population health management activities, emerging population health strategies, models of care and related trends, associated payment models, as well as a working understanding of any and all population health related program regulatory and contractual requirements to ensure compliance as appropriate.

Through collaborative partnerships with clinical, product, and analytics teams, the director is responsible for developing and implementing integrated models of care management programs and services that control medical costs, create clinical efficiencies, and improve beneficiary health, operationalizing population health initiatives throughout the organization.

Accountable for identifying and acting upon opportunities for participation or partnership in external initiatives/activities in alignment with the organizational objectives and support the achievement of specific outcomes, continuous monitoring, and process improvement.

Guides the development and implementation of case management programs and medical expense performance programs across all BCBSWY markets and products that will help to improve the health of our members through care that is cost effective and medically efficacious.

Accountable for establishing productive partnerships with providers, third-party specialized vendors, community organizations and other key ACO stakeholders, through the effective application of knowledge and understanding of clinical practice, healthcare policy and financing, risk-based provider relationships, and evolving reimbursement models and integration strategy.

Builds strategic relationships with community-based organizations, public agencies, and key community stakeholders, and the Regional Leaders to increase their understanding of population health management activities, identifying and acting upon opportunities for participation or partnership in external initiatives/activities in alignment with the organizational objectives.

Stays abreast of health care policies, regulations, and changes as it relates to population health management such as those issued by CMS, URAC, Department of Health, and/or other associated agencies or regulators; participates in certification, accreditation, and audit procedures.

Accountable for the leadership of the population health department which may include planning, developing, and growing the business and logistical aspects of department management which may include resource development and oversight (e.g., finance/budget, human resources, etc.).

Effectively utilizes data to identify greatest clinical utilization focus areas, develops programs to address those areas in partnership with clinical leadership, supports organization, market, and provides ongoing program oversight and monitoring with the goal of producing better health outcomes.

Leads initiatives to develop and implement consistent clinical management processes to improve total medical expense for all markets and products; representative accountabilities may include taking new health programs from concept to reality to scale through partnerships with clinical, operations and product teams, incorporating healthcare quality data and feedback from health plans, patients, care team members and other stakeholders to iterate and improve on programs after launch.

Responsible for defining goals, objectives, and functional activities of case management programs, and implements strategies for tracking, reporting, and achieving established goals; aligns and integrates Case Management, Population Health, and Medical Expense programs when such integration will improve results.

Works in collaboration with other teams and leaders to prioritize, research, develop and implement clinical utilization policies, procedures and best practice standards that support safe and efficient patient care; develops and nurtures cooperative partnerships to develop and implement integrated model and workflows leveraging the appropriate clinical staff for the task such as pharmacists, Case Managers, Social Workers, Community Health Workers, and other clinical shared services functions.

Identify opportunities for practice improvements configured for products and markets, pilots, and tests new approaches, institutionalizes proven practices across the organization; establishes medical expense performance onboarding processes and ongoing education for key team members.

Serve as national leader and directly oversees BCBSWY's Medical Expense Performance program and strategy. Oversees the development and implementation of programs by the population health team in all markets; provides direct supervision/ remediation oversight and intervention as needed for underperforming markets as well as identify and implement waste reduction initiatives.

This essential duties listing is not all inclusive, but representative. Other duties may be assigned.

NON-ESSENTIAL DUTIES & RESPONSIBILITIES

Serve as BCBSWY "Brand" ambassador and helping establish BCBSWY fulfill the ongoing vision of being an organization where integrity, compassion and trust define a local health insurance experience.

May be requested to act as facilitator for various in-house and/or external events, meetings, gatherings, including public-speaking, providing presentations, etc.

May serve as back-up to leadership by standing-in when requested/as may be needed.

APPLICABLE KNOWLEDGE, SKILLS, & ABILITIES (KSA)

Knowledgeable in in value-based care, medical/clinical services, managed care principles; possess and actively maintain a contemporary knowledge of the provider community and their functional environment as well as the overall health care landscape; working knowledge of healthcare financing models such as Medicare, Medicaid, SNP, PACE.

Capable of establishing appropriate professional reputation for competency and trustworthiness to effectively communicate with a wide range of individuals at multiple levels internal, and external, to the organization; external parties may include policymakers, members of government interest groups, and/or regulatory agencies.

Skilled with data analysis, interpretation, and application enabling data-informed process development and process improvement.

Ability in interpersonal relations in internal and external settings; excellent listening skills, problem-solving/problem-resolution abilities, and capable of consistently exhibiting value-aligned leadership and people management with demonstrated abilities in leading through both direct and indirect reporting models.

Proven skills in verbal and written communication, as well as project management enabling effective administration of complex programs throughout the development, implementation, management, and assessment stages.

Able to identify contemporary/upcoming impacts to the health care environment; skilled in long-term/short-term planning and incorporating forecasted potential environmental changes with ability to modify plans as may be necessary.

Proven skills in directing the implementation of policies related to population health, health services, care management, and health information analytics; knowledgeable with contracting, vendor selection/management.

Capable of professionally and effectively building and leading interdisciplinary teams; team members may represent differing/opposing positions as well as possess various levels of issue/topical knowledge; skilled with facilitating negotiations and conflict management.

QUALIFICATIONS

Earned Bachelor's degree in Health Sciences, Business Administration, Management, Finance, Health Care Administration, or related field required. Master's degree strongly preferred.

Minimum of 5 years of progressively responsible leadership roles required. Previous experience in leading and managing interdisciplinary teams strongly preferred.

5 years experience in health care or health care related business required. Directly related experience working within medical and clinal services, insurance, or health Insurance exchange services preferred.

Combination of managed care and provider-based experience highly desirable.

5 years program development and implementation experience recommended.

At least 3 years data and reporting experience, to include productivity, process, and outcomes measure development and monitoring.

Experience working with Medical Claims or other utilization data to identify clinical improvement opportunities highly preferred.

Active Driver's License required.

PHYSICAL/MENTAL DEMANDS & WORK ENVIRONMENT

While performing the essential duties of this position, an employee will typically experience:

• Standing, walking, and sitting.
• Lifting and/or moving up to 10 pounds; occasionally lifting and/or move up to 25 pounds short distances.
• Usage of close vision, distance vision, and ability to adjust focus.
• Manipulation of keyboards, keypads, and calculators.
• Placing and answering telephone calls.
• Focused task tracking and follow-through.
• Some interpersonal tension in problem-solving/resolution interactions.
• Speaking/presenting to internal and external audiences of diverse sizes.
• Work environment noise level that is usually moderate.
• Open office environment with few, if any, loud sounds, or ongoing auditory distractions.
• Some deadline related stress.
• As needed evening and weekend hours on a periodic basis.
• In-state and out-of-state travel required, most travel pre-planned, some travel may be on short-notice.

To perform successfully in this position, an individual must be able to perform essential duties satisfactorily as well as possess education/experience, knowledge, skill, and abilities (KSA) as listed in representative fashion; reasonable accommodations may be made to enable individuals with limitations/disabilities to perform the essential functions of this position. The essential duties and KSA listed are not all inclusive, but representative. Other duties may be assigned.

Blue Cross Blue Shield of Wyoming is an EOE, M/F/Vet/Disabled employer. Blue Cross Blue Shield of Wyoming uses
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