Population Health Manager (Southeast Michigan / Mid-Michigan)

Lumeris•Lansing, IL

About The Position

At Lumeris, we believe that our greatest achievements are made possible by the talent and commitment of our team members. That's why we are actively seeking talented and collaborative individuals who are passionate about making a difference in the healthcare industry. Join us today as we strive to create a system of care that every doctor wants for their own family and become part of a community that values its people and empowers you to make an impact. Position Summary: The Population Health Manager (PHM) is responsible for improving Primary Care Physician engagement with our provider network partners. The PHM position offers the opportunity to play a vital role within the Lumeris organization by collaborating cross-functionally, both internally and externally, to support the development of practice, clinic, and physician engagement. Reporting to the Market Manager, the PHM will establish significant “mindshare” within our partners including provider network PHSO and quality teams, practice administrative staff, physicians, nurses, and management. This position will drive awareness and performance around the physician engagement annual priorities with our network partners. They will drive adoption and utilization of the Maestro technology platform in support of achieving the annual physician engagement priorities, and related quality and service offerings. They will work to positively influence behavior empowering value-based care, quality metrics and cost & utilization. This person will play a critical role in fortifying the collaborative relationship we seek to establish with our physicians at the practice or clinic level and ultimately helps enable the provider to be successful within their MA plan contract. This position will require the individual to live in-market in Michigan (Southeast Michigan / Mid-Michigan).

Requirements

Minimum of 5 years of client-facing experience within the healthcare domain and experience working with physician practices including; provider relations, provider education, practice transformation and/or practice management
Demonstrated subject matter expertise in any of the following areas: Medicare advantage, managed care regulations, quality reporting, care management, population management, and supporting providers in risk-based contracts.
Strategic and entrepreneurial outlook with strong collaborations skills
Demonstrated change management expertise
Ability to operate independently and lead complex client interactions
Ability to operate in a fast-paced and dynamic environment
Team player, excellent communication skills
Demonstrated understanding of healthcare metrics and use of analytical skills
Extensive knowledge of the U.S. healthcare system
Exceptional client-facing skills
Excellent presentation skills

Responsibilities

Develops and maintains long-term relationships and client satisfaction by serving as the primary liaison between the external client and internal cross-functional departments. External client relationships include the following teams/individuals: Provider network PHSO and quality teams, practice administrative staff, physicians, nurses, client health plan provider relations team
Organizes cross-functional teams and workflows to proactively identify and resolve potential problems.
Monitors compliance with health plan procedures and policies.
Acts as the main point of contact regarding all constituent issues surrounding practices, clinic, physicians, and patient operations.
Responsible for training and coaching users on how to use the population health technology platform to achieve excellent performance in the physician engagement priorities and focus areas. This position requires experience and understanding of analytics used to support population health management and success in value-based contracts
Responsible for driving success in plan focus areas, including the following: Access to Care: Partnering with provider offices to utilize Access to Care analytics and best practices to ensure members are seen by their primary care physician. Quality Metrics: Familiarity with HEDIS quality measures and engaging with the quality teams in the provider networks to achieve performance in contract quality metrics. Partnering with provider offices to coach on pre-visit planning and closure of gaps in care utilizing worklists. HCC Risk Adjustment: Experience with Risk Adjustment strategies to ensure accurate documentation and coding of risk-adjusted patient populations to ensure appropriate patient acuity capture. Partnering with the Lumeris RAF team and provider offices on the successful execution of initiatives.
Compiles, analyzes, interprets, and presents data related to clinical performance to influence value-based care, cost, utilization, and quality care improvement processes.
Development and implementation of initiatives to improve performance against value-based contract metrics, including the following: High-risk patient follow-up (after inpatient discharge, after ER visit, for complex cases) Identification of pharmacy management opportunities (promoting generics, medication adherence, step therapy) Keeping abreast of current industry, market, and policy landscape