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Population Health Specialist - MassHealth ACO

Company: Beth Israel Lahey Health
Location: Wakefield
Posted on: May 28, 2023

Job Description:

When you join the growing BILH team, you're not just taking a job, you're making a difference in people's lives.
Job Type:
Scheduled Hours:
Work Shift:
Day (United States of America)
Under the supervision of the Quality Manager, the Population Health Specialist (PHS) supports collaboration, communication and care coordination with all members of the health care team, including but not limited to POD leaders, practices, clinicians and hospital leadership.
The Population Health Specialist is the primary point of contact with and an integral member of the health care team. They will work to ensure safety, best practice and high quality standards of care across the health care continuum to achieve the quality incentives as part of global payment and managed care contracts with the goal of optimizing our patients' health and well-being, ensuring that contractual metrics are met, and maximizing financial revenue in our quality risk arrangements.
This role is responsible for the communication of targets for medical expense trend and quality outcomes and the facilitation of activities to meet identified targets through analysis of quality, cost and utilization reports.
Assists the health care team in implementing and using systems and interventions to improve patient care and outcomes by identifying key drivers
of performance and implementation of project plan(s) initiatives to impact those key drivers
Job Description:
The Population Health Specialists Responsibilities are:

  • Serves as subject matter expert on HEDIS ambulatory quality measures and uses that knowledge to effectively communicate information as the central resource to assigned hospital, POD leaders, physician groups and clinical teams participating in the BILPN risk arrangement quality programs

  • Acts as a key resource to practice(s) for the management of registries of patients that have chronic diseases to ensure they have the required testing and medication management to promote optimal health and clinical outcomes. Ensures pre-visit planning, reminders and processes on day of visit and subsequent tests and referrals following visits to improve population health

  • Works collaboratively with practice/providers to develop campaigns to address gaps in care, monitors patient and practice/provider compliance with campaigns and provide feedback and adjustment as needed to ensure success.

  • Supports process improvements to enhance clinician and staff workflows by identifying potential barriers and making recommendations on improvement initiatives. Audits performance based on recommendations and evaluates compliance and engagement. Effectively communicates key findings to drive informed decision making

  • Provides expertise, training, and ongoing support for quality measures and the EHRs and related clinical and technical systems which support the collection and tracking of such measures.

  • Performs monthly review of key analytic reports to track overall POD and provider performance by extracting data from the analytic tool(s) and practices' electronic medical record. Ensures POD, practices, and clinicians are informed on current performance and areas of opportunity for improvement

  • Provides an effective communication link between POD leaders, practices and clinicians and BILPN leadership. Escalates issues and/or concerns with practice engagement, participation or performance to quality manager and medical director as needed.

  • Identifies and communicates best practice opportunities to POD leaders, practices, clinicians and team members to help improve performance. Participates in team decisions regarding data requirements for pro-actively managing the team's panel

  • Participates as necessary on payer audits for numerator compliance and exclusions on quality measures

  • Coordinates with Manager of Quality to track and share data with practice on patient experience improvement measures and performance against.

    Minimum Qualifications:
    Education: Bachelor's Degree
    Licensure, Certification & Registration: Medical Assistant Certification or 3-5 years related experience in a health care environment. Experience:3-5 years related experience in a health care environment
    Skills, Knowledge & Abilities:
    Strong knowledge of and experience with HEDIS ambulatory quality measures a must.
    Ability to travel to offsite meetings at various provider practices and hospitals
    Strong knowledge in Microsoft Office applications - Word, Excel, Access, PowerPoint and other web-based applications.
    May produce complex documents, perform analysis and maintain databases
    Knowledge of process improvement initiatives such as LEAN or Six Sigma a plus
    Knowledge of electronic medical records; eClinical Works, Athena, GE Centricity or Epic a plus.
    FLSA Status:
    As a health care organization, we have a responsibility to do everything in our power to care for and protect our patients, our colleagues and our communities. Beth Israel Lahey Health requires that all staff be vaccinated against influenza (flu) and COVID-19 as a condition of employment. Learn more ( about this requirement.
    More than 35,000 people working together. Nurses, doctors, technicians, therapists, researchers, teachers and more, making a difference in patients' lives. Your skill and compassion can make us even stronger.
    Equal Opportunity Employer/Veterans/Disabled

Keywords: Beth Israel Lahey Health, Boston , Population Health Specialist - MassHealth ACO, Healthcare , Wakefield, Massachusetts

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