Practice Transformation Specialist (Full-time Remote, North Carolina Based)

The Practice Transformation Specialist (PTS) works with Advanced Medical Homes (AMH+) and Care Management Agencies (CMA) in the Alliance Health region to improve quality of care. This position serves as a consultant to provider practice staff to improve patient outcomes by enhancing skills in process improvement, team-based care, encouraging patient engagement, sharing identified practice population trends, and analyzing quality data and performance measurements. The Practice Transformation Specialist also collaborates with the Alliance Health Clinical Operations team in the development, implementation, and optimization of training materials used to facilitate practice transformation in the Alliance Provider Network. The Practice Transformation Specialist works with Clinically Integrated Networks to advance provider-p-led care management toward alternative payment models.

Provide Support to Network Providers

• →Assist providers to evolve administrative and clinical workflows and processes aimed at improving outcome-based care.  This starts with assisting care management providers with setting up their sites for billing, through claims processing and the shift to data informed care management -to include creating interventions, workflows and guidance with policy and procedures. This also includes understanding the data sent to the care management agencies and how to readily make the data usable for care managers
• →Educate practice’s and CINs in CQI principles and practice.  This includes education and coaching on different interventions, Plan, Do, Study, Act cycles, data used to drive care thus leading practices to improved member outcomes. This work will be coordinated with the clinically integrated networks (CINs)
• →Meet with providers and CINs to review performance reports (including panel and engagement rates quality dashboards (including Gaps in Care, Medical Economic Dashboards (ED visits and utilization), and other data points that will drive CINs and Providers to improve member care. Practice Transformation Specialist must present data in an understandable format
• →Collaborate with AMHs and CMA to support integrating administrative, financial, and clinical systems and data for better performance and improved outcomes; this includes conducting reporting on Gaps Analysis, using the Gaps Analysis and CQI Rubric to strengthen the performance of the care management entities, to present to the applicable CINs
• →Facilitate agencies adoption of 1915(i) processes and impacts of HR. 1 and other state programs for their members

Provide Training & Coaching to Network Providers

• →Deliver practice-level education, training and provide providers with toolkits for improving member care; including HEDIS Measures; Alliance operational initiatives and state requirements; such as 1915 I and HR.1
• →Educate on available resources and systems, such as JIVA and NCCARES 360, Inovalon, Siftwell’s Pegasus, Alliance’s Medical Economics dashboards, and MicroStrategy reports.  This includes knowledge of the technical files sent to the CINs and Care Management agencies and how to use the data from files to improve member outcomes
• →Provide customized coaching at clinical sites (e.g. community health centers, PCP offices and comprehensive behavioral health provider sites) by working with the sites to identify site-specific needs and opportunities, prioritizing areas of focus and identifying available and needed resources. Coaching includes use of data for data informed CM, CM Supervision and driving to alternative payment models
• →Create and deliver presentations on various topics, including data informed CM, Value Based Contracting, CQI and how to shift providers to alternative payment models (shared savings) to improve member care
• →Articulate requirements for state changes like 1915 (i) and HR.1; data informed care management, gaps analysis for data; continuous quality improvement and interventions to drive improved member outcomes

Provide Data Support to Network Providers

• →Work with practice sites to produce reports on their progress on quality, financial, and utilization goals and share outcomes of quality and clinical measures

Support Implementation of Provider-Led Care Management

• →Ensure implementation with fidelity to care model. Including creating tools that will allow the provide to obtain sustainability
• →Transparently share challenges and barriers regarding site implementation and share solutions for effectively implementing the interventions
• →Guide clinical staff and leadership on the implementation of best practices
• →Address barriers to effective implementation of improvement processes
• →Propose solutions for practices/health centers to consider in addressing barriers
• →Assist providers in panel management and guide providers through understanding of panel assignments

Cross-Department Collaboration

• →Work as part of an interdisciplinary team to create and deliver products and services including user education and training materials, project plans, tool kits, and evaluation materials. Drive project plans to enable implementation and use of the tools and training materials
• →Works with QM, Provider Network Evaluation, Care Management and Finance departments to identify areas of opportunity and improvement related to network care management entities and large primary care systems
• →Work closely with the IT department to understand the files and documents sent to care management agencies and understand IT processes so that when changes are made to files and data sources they can be properly communicated to the providers
• →Communicate and collaborate with Care Management Liaisons to resolve the providers member facing barriers, issues and concerns
• →Foster relationships across teams to set up services for tailored care management entities and the PCP providers with value cased contracts

Education & Experience

Required:

Bachelor’s degree in nursing, social work, or other human services related field and five (5) years of post-degree experience in healthcare or managed care. 

Preferred:

Experience leading healthcare quality and process improvement initiatives in an operational setting, particularly within community health, is preferred.

Experience in public speaking, mediation, presentation development, training, group facilitation, advocacy, regulatory compliance, and project management is preferred.

• Understanding of Health Information Technology (HIT) and its role in improving healthcare outcomes.
• Knowledge of the fundamentals of lean or PDSA process improvement 
• Moderate analytic knowledge (including pivot tables, Pareto analysis, sources of errors in data, risk adjustment, price/volume variance analysis, application of benchmarks, coefficient of variance) 
• Understanding of specifications of quality, utilization and financial metrics, specifically HEDIS
• Knowledge of population health, social determinants of health and clinical integration
• Moderate project management skills (including ability to map dependencies, identify critical path)  
• Proficiency in Microsoft Office Professional products, PowerPoint
• Customer service principles 
• Effective listening skills
• Detail oriented and highly organized
• Ability to work independently and make strategic decisions based on information gathered over time.
• Ability to prioritize workload as appropriate to ensure on‐time project completion
• Excellent verbal/written communication, interpersonal, analytic, and customer service skills
• Ability to use data to drive change; including presenting data performance to providers
• Ability to work effectively on simultaneous projects with competing priorities
• Ability to function in a team‐based work environment collaboratively and collegially
• Ability to generate trust and build collaborative relationships internally and externally
• Knowledge of CPT, ICD, and HCPCS coding