PacificSource Health Plans

Vice President, Population Health

US-OR-Portland
Job ID
2017-430
Type
Regular Full-Time
# of Openings
1
Status
Exempt

Overview

Co-lead the development of Population care with PacificSource members and Legacy Health in: disease management, complex care management, utilization support, health promotion, new care paths.  Understand best practice and evolving practices in Primary care, behavioral health and Specialty care. Take the learnings from the work with Legacy and implement Population Health programs with other Preferred groups in key geographical locations in all states we reside in.

Responsibilities

  1. Develop pathways with Legacy leadership around population health leading to exceptional health outcomes as measured by HEDIS, 5 star and NCQA.
  2. Work with PacificSource IT in streamlining analytics and patient metrics into operational care paths with Legacy.
  3. Leads communication regarding population health with internal Health Services team through the PHD leadership team, Legacy/PS project manager and HS Senior staff members.
  4. Supports the development of new products and relationships with Legacy.
  5. Track progress of quality outcomes, member satisfaction.
  6. Actively participate in various strategic committees in this work.
  7. Coordinate business activities by maintaining collaborative partnerships with key departments.
  8. Develop and monitor health outcomes and financial performance.
  9. Support processes that optimize Risk Scores.
  10. Supervise the Condition Support teams and Care Management teams, all LOBs, in work consistent with Population Health
  11. Streamline processes for Care Management, all Lines of Business. Build a team and Care Management model that will be flexible and effective with significant growth plans.
  12. Responsible for oversight, management, development, implementation and communication of department programs.
  13. Responsible for hiring, staff development, coaching, performance reviews, corrective action and termination of employees.
  14. Develop and monitor annual department budgets.
  15. Coordinate business activities by maintaining collaborative partnerships with key departments.
  16. Actively participate as a key team member in EMG meetings.
  17. Actively participate in various strategic and internal committees in order to disseminate information within the organization and represent company philosophy.
  18. Develop and implement a population health strategy for key geographic locations.

Supporting Responsibilities:

  1. Meet department and company performance and attendance expectations.
  2. Follow the PacificSource privacy policy and HIPAA laws and regulations concerning confidentiality and security of protected health information.
  3. Perform other duties as assigned.

Qualifications

Work Experience: At least 5 years’ experience in an executive healthcare or public health role with varied clinical focus, quality focus and plan knowledge. Experience and understanding of NCQA or URAQ standards. Understanding of CMS, federal/state regulations.  Experience in system design, strategic planning in health care operations.

 

Education: Health Care professional such as MD, DO, RN, MSW.  Bachelors’ degree required and Master’s level in Health care or other relevant field preferred.

 

Knowledge: Knowledge and understanding of disease prevention, medical procedures, diagnoses, care modalities, procedure codes, including ICD-9 & 10 CPT Codes, health insurance and state mandated benefits. Ability to develop, review, and evaluate utilization reports. Knowledge of quality improvement methodology. Knowledge of principles of adult learning and/or motivational interviewing. Experience giving presentations. Good organizational skills with experience in using computers and various software applications including Word, Excel, PowerPoint, Outlook, SharePoint, and audio-visual equipment. Ability to work independently with minimal supervision.

 

  • Authenticity
  • Building Organizational Talent
  • Coaching and Developing Others
  • Compelling Communication
  • Customer Focus
  • Empowerment/Delegation
  • Emotional Intelligence
  • Leading Change
  • Managing Conflict
  • Operational Decision Making
  • Passion for Results

 

 

  • We are committed to doing the right thing.
  • We are one team working toward a common goal.
  • We are each responsible for our customers’ experience.
  • We practice open communication at all levels of the company to foster individual, team and company growth.
  • We actively participate in efforts to improve our many communities-internal and external.
  • We encourage creativity, innovation, continuous improvement, and the pursuit of excellence.

 

 

Environment: Work inside in a general office setting with ergonomically configured equipment. Travel is required approximately 15% of the time.

 

Physical Requirements: Stoop and bend. Sit and/or stand for extended periods of time while performing core job functions.  Repetitive motions to include typing, sorting and filing. Light lifting and carrying of files and business materials. Ability to read and comprehend both written and spoken English. Communicate clearly and effectively.

 

Disclaimer: This job description indicates the general nature and level of work performed by employees within this position and is subject to change. It is not designed to contain or be interpreted as a comprehensive list of all duties, responsibilities, and qualifications required of employees assigned to this position. Employment remains AT-WILL at all times.

 

PacificSource is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to status as a protected veteran or a qualified individual with a disability, or other protected status, such as race, religion, color, national origin, sex, sexual orientation, gender identity or age.

 

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