Job Description

Position Purpose:

Steward Health Care Network (SHCN) takes pride in its community-based care model, which drives value-added tools and services to our communities, patients, physicians, and hospitals across the continuum of care. In addition, Steward Health Care Network promotes care coordination and collaboration within the network in order to provide high-quality, efficient care to patients. With Steward in the community, all residents can be sure that there is a world class doctor close to where they live.

The network is also responsible for the implementation and execution of our managed care contracts, medical management services, quality improvement programs, data analysis, and information services.

The Performance Manager oversees the training and field work of the performance team in collaboration with the Sr. Manager of Quality and Risk Adjustment, this position is responsible for the program development, hiring, training and field implementation in physician practices with opportunities for improved quality, risk adjustment and clinical workflow (referral management and population health management) performance. As a field manager, this position is a valuable resource to the Regional Performance Operations Team.

Key Responsibilities:

  • Reviews for clinical indicators and query providers to capture the severity of illness of the patient. Interacts with providers regarding billing and documentation policies, procedures, and conflicting/ambiguous or non-specific documentation. Works in collaboration to key stakeholders, large group and local chapter operations team. Supports process improvement to enhance physician and staff workflow. Supports medical record data review/collection for appeals and exclusions at the time of data submission per contractual obligations. Participates in office/practice team huddles as appropriate. Works with SHCN Patient Registry and practice Electronic Health Record or paper record to support SHCN reporting and monitoring of quality performance and risk adjustment.
  • Works collaboratively with the SHCN Performance Operations team to coordinate improvement efforts related to overall performance. Oversees the assessment of performance in relation to established goals and standards; participates in the recommendation of new approaches, policies, workflows, and procedures to effect continual progress toward goals and standards. Implementation of performance improvement plans at the practice level. Oversees improvement within physician practices that will drive or have a direct impact on process improvements and enhancing clinical workflows. Produces and maintains record by keeping database up to date and reporting progress on a weekly basis and to determine impact of interventions. Ensures compliance with all applicable Federal, State and/or County laws and regulations related to coding and documentation guidelines for Risk Adjustment and HEDIS measures
  • Consults with the Sr. Manager of Quality and Risk Adjustment and other stakeholders on the development of goals and standards that align with the strategic plan of SHCN. Provides expertise to develop and sustain process improvements at all levels of the organization. Provides dashboard reports to performance team, providers and practices and recommendations on improvement. Works collaboratively to solve problems, to improve processes, and to integrate services within physician practices.
  • Maintain collaborative team relationships with peers and colleagues in order to effectively contribute to the working group's achievement of goals, and to help foster a positive work environment. Collaborates across functional departments to support and implement changes/enhancements. Provides leadership in planning, reporting, evaluating, and facilitating improvement processes to increase effectiveness and efficiency in SHCN member practices. Manages the development of effective communication methods to keep staff and others informed about improvement activities of the practice.
  • Provides SHCN Performance Operations and practice staff with appropriate level of clinical training relative to performance measures including but not limited to spirometry, ABIs, taking and recording a blood pressure, urine collection and diabetes in-office testing. Coaches the performance team on the effective design and implementation of plans for continuous improvement and best practices within physician practices. Assists in preparation of training materials (internal or external). Present to key stakeholders, vendors and large groups.

Education:

  • Bachelor’s degree or equivalent experience preferred.
  • Medical Assistant certification or LPN license preferred.

Years of Experience:

  • 1-3 years of supervisory/management experience preferred.
  • Clinical background (Medical Assistant or LPN) with coding (HCC/MRA) experience preferred.
  • Experience in quality and risk adjustment preferred.

Specialized Knowledge:

  • Familiarity and understanding of CMS HCC Risk Adjustment coding and data validation requirements, as well as HEDIS.
  • Strong knowledge in Microsoft Office applications – Word, Excel, Access, PowerPoint.

Application Instructions

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