This dynamic position is at the forefront of healthcare transformation serving as a catalyst for healthcare reform in the San Fernando Valley. If you have an innovative, forwarding thinking & data-minded approach to healthcare, we encourage you to apply to join our team! The Managed Care Operations Analyst will leverage value based care approaches to help implement CAL AIM and APM practices, focusing on optimizing technology and data systems to develop best practices for patient centered care. This integral team member will “paint a story” with managed care and utilization data, collaborating with executive leadership to meet and exceed organizational goals.
CORE JOB RESPONSIBILITIES (Essential Duties):
- Defines, collects, analyzes, and reports on Key Performance Indicators (KPIs), supply & demand trends, membership demographics, and forecasting for new programs to meet health plan and APM/CAL AIM requirements.
- Optimizing all internal and external data, “Tells a story” about how the organization is performing on managed care utilization metrics including but not limited to: total cost of care data (hospital, ER, referrals to specialists, Medicare measures, member retention, patient experience), primary care usage and linkage, programs (Annual Wellness Visits) other data that supports the quadruple aim goals.
- Collaborates with the Access taskforce lead to develop and update provider risk profiles to understanding appropriate empanelment and appropriate utilization of VCH services
- Collaborates with a cross-functional leadership team to formulate, implement, assess, refine, and evolve strategies to grow membership capabilities.
- Ensures contracted health plans and MSOs credential and privilege (C&P) existing and new providers (Physicians/Advanced Practitioners). Works with internal departments and MSOs to streamline C&P processes and establishes a strong rapport with VCH community partners (IPAs, MSOs, and Health Plans etc.) Acts as a liaison to mitigate issues, working with partners to develop agreed upon solutions
- Partners with MSO and Health Plans to advocate for VCH patients and ensure patients access managed care benefits
- Oversees and guides the development of management reports to track, trend, and analyze metrics necessary to evaluate performance under each value-based contract and across the portfolio of contracts
- Provides data to help inform the Managed Care Utilization Committee (MUCH) Committee to further goals, share relevant data and determine action steps across multiple departments
- Facilitates analysis of operational, financial, and clinical data to identify opportunities for developing programs and initiatives that promote success in VBP arrangements.
- Collaborates with the Operations team to develop strategies to increase access to care and membership growth
- Collaborates with Quality Improvement Director to supply HEDIS and other Managed Care metrics data to optimize VCH quality patient care and develop strategies to meet or exceed performance goals.
- Maintains current knowledge of market landscape and strategic insights on value-based care needs. Incorporates knowledge in providing recommendations and implementing changes.
- Serves as a knowledgeable resource for certain Value-based Purchasing (VBP) contracts and communicates operational, quality, and financial data requirements and benchmarks to the leadership team.
- Other duties as assigned.
Required Knowledge/Skills/Abilities:
- An aptitude for increasing access to care for the underserved communities of the San Fernando Valley
- Working knowledge of managed care principles, medical claims payment process, medical terminology and coding, and Medicaid programs or passionate ability to quickly learn
- Working knowledge of how electronic health records, health information exchanges, business intelligence/analytics technology interface and enable population health strategies.
- Ability to work with large data sets in excel and power BI
- Exceptional verbal, listening, and written communication skills to effectively present to key stakeholders and achieve buy-in
- Strong interpersonal skills with the ability to quickly build relationships and establish trust.
- Ability to analyze complex data and communicate observations in a simplified manner.
- Expertise in a variety of computer programs including Microsoft Outlook, Word, Excel, and PowerPoint. Proficiency with NextGen, i2iSystems, LANES, EDDY, electronic medical record systems and quality platforms is preferred.
- Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions of the job.
POSITION REQUIREMENTS:
These specifications are general guidelines based on the minimum experience normally considered essential to the satisfactory performance of this job. Individual abilities may result in some deviation from these guidelines.
Qualification Requirements:
- Bachelor’s Degree in Healthcare Administration, Public Health, Business Administration or related field.
- Proficiency in a variety of information systems (EMR, population health management software, health information exchanges).
- Previous experience in a leadership role in FQHCs, preferred
- Previous experience in a managed care organization, Health Plan and/or IPA, preferred
- Experience with using analytics and information technology to advance programmatic design, implementation and evaluation.
- Extensive experience in Microsoft Excel with the ability to quickly turn data into information
- Experience evaluating and modifying programmatic approaches to improving population health.
Job Type: Full-time
Pay: $70,000.00 per year
Benefits:
- 401(k)
- 401(k) matching
- Dental insurance
- Employee assistance program
- Health insurance
- Health savings account
- Paid time off
- Vision insurance
Schedule:
- 8 hour shift
- Monday to Friday
Experience:
- NextGen: 1 year (Preferred)
- EHR systems: 1 year (Preferred)
- Outpatient: 1 year (Preferred)
- FQHC: 1 year (Preferred)
- Healthcare IT: 1 year (Preferred)
- Clinic: 1 year (Preferred)
Work Location: In person