Job Description

Category:
Management/ Professional

Facility:
Steward Health Care Network

Department:
Steward Health Care Network

Req Number:
49838

Job Details:

POSITION SUMMARY:
The Chapter Performance Manager under the guidance and supervision of the Regional Performance Director will be responsible for the performance of the Local Chapter under managed care arrangements. The focus of the work will be on assisting in the development and implementation of chapter performance plans that pertain to quality, efficiency, patient satisfaction, care retention and accurate coding while maximizing risk-based reimbursement for populations covered under risk contracts.

KEY RESPONSIBILITIES:

The Chapter Performance Manager will have responsibility for the following:
* Under the supervision of the Regional Performance Director, the Chapter Manager leads the Chapter, and all its providers to meet or exceed all performance goals as set forth by the SHCN MA Regional Board of Directors in an effort to advance the Steward Community Care model, maximize patient and provider satisfaction, implement standards of care and maximize risk-based revenues in close collaboration with physicians, clinical management team, and network hospitals.
* With the guidance of the Regional Performance Director, assesses the performance improvement needs of provider practices across the Chapter and coordinates all SHCN resources on the Local Chapter Performance Team to assist Chapter providers with maximizing value delivered to all key stakeholders.
* Produces regular performance reports on all strategic initiatives. Establishes and implements appropriate performance improvement plans to raise Chapter performance in order to meet or exceed Chapter goals.
* Documents all pertinent communication and interactions with providers via the Provider Database CRM tool allowing for enhanced collaboration across Steward
* Reviews individual physician performance in risk products and implements educational efforts and action plans as needed. Becomes local expert in all processes and technology driving referral management, quality program, SHCN's Distribution Model, care management referrals and high-risk patient management.
* Owns Network Management functions for all providers within the Local Chapter. Works with SHCN's Managed Care, Enrollment and Analytics departments on issues such as provider database setup and maintenance (active vs. termed, groups vs. individuals, addresses and other contact information), contracting including PPAs, acquisition of appropriate W-9s, signature and filing of Physician Pacts, etc.
* Has knowledge on all PCPs and Specialists within assigned Chapter, including key information such as group membership, affiliations, and historically contextual elements.
* Interfaces with Steward Network Development (recruiting) as requested to grow and maintain the provider network.
* Ensures that new SHCN providers are effectively supported throughout the on boarding process and acts as a central point of contact when issues arise that require escalation.
* Works with the Referral Management Team and Local Chapter Medical Director in accordance with the Chapter's specified referral management process to drive patient care into Steward Health Care Network and capture volume in our low-cost, high-quality Community Care Model.
* Monitors the availability of in network service gaps that need to be filled in order to keep patient care services in the Steward system and proactively manages physician and key hospital leadership relationships and brings critical issues needing attention to the SHCN and Chapter leadership team.
* Advocates for those services and resources that need to be brought to bear on improving the overall experience of providers in SHCN (e.g. additional IT support, new tools to manage referrals, etc).
* Fosters a culture of collaboration and teamwork amongst practices and the entire field operations team.
* Collects and distributes materials essential for meetings, meeting documentation and follow-up, leveraging the Chapter Team's Administrative/Provider Relations support resource for material preparation, scheduling, meeting minutes, provision of food and beverage, etc.
* Communicates regularly through various communication methodologies, including one on one or group meetings, with local providers and their staff consistent with the key messages disseminated from the SHCN Governance Structure at the direction of the SHCN Leadership Team. Develops and provides education to provider and office staff regarding initiatives of the local chapter and SHCN including health plan updates.
* Escalates concerns to Regional Director when appropriate in a timely fashion
* Demonstrates respect and regard for the dignity of all patients, families, visitors and fellow employees to ensure a professional, responsible and courteous environment.
* Commits to recognizing and respecting cultural diversity for all customers (internal and external).
* Performs other duties as assigned.

REQUIRED KNOWLEDGE & SKILLS:

* Strong knowledge of managed care; ability to work independently and prioritize under short deadlines;
* Experience working with physician practices; demonstrates an understanding of practice operations;
* Strong communication skills; ability to interact with clinical care team and physicians in appropriate manner;
* Demonstrated quantitative and analytical skills; excellent organizational capabilities; good attention to detail;
* Strong sense of diplomacy and ability to work under pressure;
* Ability to work in a dual reporting (matrix) environment;
* Ability to balance conflicting priorities;
* Ability to regularly travel to MD offices, nursing homes and hospitals.

EDUCATION/EXPERIENCE/LICENSURE/TECHNICAL/OTHER:

I. Education: Bachelor's degree or equivalent experience; Masters degree a plus;
II. Experience: Two to four years in managed care and physician practice office management; clinical background a plus;
III. Certification/Licensure: N/A
IV. Software/Hardware: Strong knowledge in Microsoft Office applications - Word, Excel, Access, PowerPoint; working knowledge of Salesforce; proven ability to learn new information systems as necessary
V. Other: Understanding of the health care delivery setting. Experience with diverse populations a plus.



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