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Posted: Monday, January 8, 2018 1:23 AM

Job Summary: Assists in the design, implementation, and support of a robust enterprise-wide population health management program, including managed care; consistent with the goals of the Population Health, the Physician Lead, Complex Care Managementcontinually develops and drives strategies that focus on improving outcomes and managing costs through use of data analytics, application of technology and innovative care processes. DUTIES # ESSENTIAL JOB FUNCTIONS: NOTE: The following are the duties performed by employees in this classification, however, employees may perform other related duties at an equivalent level. Not all duties listed are necessarily performed by each individual in the classification. 1.# Works with Vice President, Population Health on developing a utilization management function for managed care patients which includes out-of-network concurrent review, repatriation, retrospective medical claim review, provider medical claim appeal review and prior authorization out-of-network outpatient services. 2.# Works with Vice President, Population Health on developing a quality management and clinical compliance program for managed care patients which includes quality management, clinical compliance, health education and case review. 3.# Provides physician direction for Complex Care Management activities. 4.# Works collaboratively with the Vice President, Care Management and other clinical leaders within Population Health on care coordination and complex care management initiatives. 5.# Provides clinical guidance and oversight to the AHS Hope Center which provides care management services to patients who are high utilizers.# 6.# Provides input on AHS policies and procedures, desktop procedures, workflows, job aides, training materials to help ensure that they are current and accurately reflect processes in order to provide consistent quality care and meet compliance with regulatory and AHS requirements.. 7.# Participates on an interdisciplinary committee to implement health care predictive analysis and risk stratification tool(s) that will help AHS provide targeted, proactive, relationship-based (longitudinal) care coordination and care management to impaneled patients identified as at increased risk and who are likely to benefit from intensive care management, including patient visits in the hospital and post-acute settings. 8.# Works collaboratively with Population Health team to develop and prepare departmental scorecards and dashboards showing high level results and trends. 9.# Participates in planning initiatives to create a foundation for population health management, includes identifying relevant populations, creating a strong data governance mechanism, adopting of population health analytical tools, implementing an effective population health analytics solution for providers, analyzing care outcomes, designing and/or redesigning services based on data analysis and patient needs. 10. Serves as the AHS clinical lead for its participation in the County of Alameda#s Whole Person Care Initiative (Alameda County Care Connect). 11. Serves as the AHS clinical lead for its participation in the Alameda Alliance for Health#s Health Home#pilot. 12. Performs other duties as assigned. Minimum Qualifications: Required Education: Doctorate of Medicine. Required Experience: Five years of progressive experience with programmatic and operational responsibility; experience in healthcare, specifically in integrated delivery system operations and/or payer experience; experience developing and implementing clinical, service, and operational process improvement initiatives on both a small and large scale; experience in a hospital/health system environment with diverse services, patients and staff. Preferred Experience: Experience building external relationships with physicians, clinical staff and other members of care teams in developing clinical programs focused on disease management or population health desired. Required Licenses/Certifications: Licensed to practice medicine in the state of California. Preferred Licenses/Certifications: Board certification.

Qualifications:

Required Education: Doctorate of Medicine.

Required Experience: Five years of progressive experience with programmatic and operational responsibility; experience in healthcare, specifically in integrated delivery system operations and/or payer experience; experience developing and implementing clinical, service, and operational process improvement initiatives on both a small and large scale; experience in a hospital/health system environment with diverse services, patients and staff.

Preferred Experience: Experience building external relationships with physicians, clinical staff and other members of care teams in developing clinical programs focused on disease management or population health desired.

Required Licenses/Certifications: Licensed to practice medicine in the state of California.

Preferred Licenses/Certifications: Board certification.

SDL2017


Associated topics: bilingual, care, care physician, family practice physician, nocturnist, outpatient, physician md do, practice physician, primary, urgent care

Source: http://www.jobs2careers.com/click.php?id=4739735549.96


• Location: East Bay

• Post ID: 93160217 eastbay
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