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Supervisor, Population Health Management (Quality Initiatives)

Company: CalOptima
Location: Orange
Posted on: June 10, 2021

Job Description:

Department(s): Population Health Management (PHM)

Reports to: Manager, Population Health Management

FLSA status: Non-Exempt

Salary Grade: M - $85,000 - $121,000

Job Summary

The Supervisor of Population Health Management will be responsible for daily operation of Population Health Management activities and supervision of Population Health Management staff. The Supervisor will work under the direction of the Manager and in partnership with the Director and/or other department leadership to support department goals and program implementation. The Supervisor will provide guidance to staff, directly handle complex Population Health Management referrals and requests for Population Health Management services, monitor staff goals and productivity, ensure compliance with cultural and linguistic requirements and processes, and compliance with desktop procedures, organizational policies, or contractual requirements. Serve as a resource for CalOptima providers, health networks and community partners. Flexible schedule requires availability to participate in evening and weekend events.

Position Responsibilities:

  • Oversees the process, management, implementation, and evaluation of quality initiatives such as improvement projects, member and provider incentive programs, provider education activities, targeted member outreaches, etc.
  • Contributes significant narrative for regulatory deliverables including PDSA, PIPs, QIPs, CCIPs and other quality improvement projects for various regulatory and accreditation agencies (DHCS, CMS and NCQA).
  • Analyzes health care data and be able to assess statistical validity of rate changes to inform evaluations and future planning or strategy adjustments.
  • Demonstrates leadership and oversight ability by providing staff guidance, training, and support for the implementation of improvement projects, special projects, and pilot programs which may include activities such as holding focus groups, conducting research or surveys.
  • Assists with QI work plan strategic planning, implementation and write up of annual evaluation using evidence-based findings showing how efforts have closed gaps in care in HEDIS, MCAS and other organizational goals.
  • Facilitates meetings with PHM staff, other department staff or other community organization collaborators in planning execution of initiatives.
  • Ensures adherence to regulatory requirements for quality improvement projects such as completing and submitting quality improvement projects, performance improvement projects, rapid cycle improvement projects, and improvement plans.
  • Collaborates with various departments to obtain data, send communications, and implement quality improvement activities.
  • Partners with the Population Health Management leadership to develop and member and provider interventions in support of department initiatives.
  • Supports the Manager of Population Health Management with the development, tracking and updating of Population Health Management and member informing materials to ensure compliance with regulatory requirements.
  • Participates in the hiring process and training of new Population Health Management staff.
  • Provides guidance and support for the implementation of special projects and pilots, or directly handle complex Population Health Management requests from members, providers, or staff.
  • Assists with the development and oversight of Population Health Management programs, work plans, budgets, and reports.
  • Assesses activities and other process improvement strategies to enhance the effectiveness of Population Health Management services.
  • Aids with developing, documenting, implementing, and updating desktop procedures.
  • Acts as a resource for CalOptima providers, health networks and community partners.
  • Participate in internal and external committees, coalitions, and events such as health fairs as appropriate.

Maintains knowledge of the latest advances and research on various health topics.

  • Other projects and duties as assigned.

Possesses the Ability To:

  • Establish and maintain effective interpersonal relationships with staff at all levels, providers, other program or agency representatives, and the general public.
  • Systematically evaluate work and apply skills to continuously improve processes.
  • Provide excellent customer service.
  • Initiate and follow through on projects with minimal supervision.
  • Work well as part of a team to manage/lead multiple projects simultaneously.
  • Think critically to solve problems effectively.
  • Communicate clearly and concisely, both verbally and in writing with individuals from varying cultural and ethnic backgrounds.
  • Utilize computer and appropriate software (e.g., Microsoft Office: Word, Outlook, Excel, PowerPoint) and job specific applications/systems to produce correspondence, charts, spreadsheets, and/or other information applicable to the position assignment.

Experience & Education:

  • Bachelor's degree in Public Health or related field required.
  • 5+ years Population Health Management experience required.
  • 2+ years of Supervisory/Lead experience required.

Preferred Qualifications:

  • Master's degree in Public Health or Health Science highly preferred.
  • Population Health Management experience in a Managed Care setting preferred.
  • Project Management experience preferred.
  • Bilingual in English and in one of CalOptima's defined threshold language (Spanish, Vietnamese, Arabic, Farsi, Korean, Chinese) preferred.

Knowledge of:

  • Population Health Management program planning and evaluation.
  • Health Effectiveness Data Information Set (HEDIS), National Committee for Quality Assurance (NCQA), Centers for Medicare & Medicaid Services (CMS), Department of Health Care Services (DHCS), and other quality performance standards.
  • Performance improvement projects, Plan-Do-Study-Act (PDSA).
  • Techniques of project management, quality, and research methods.
  • Culture and needs of the socially and ethnically diverse population CalOptima serves.

CalOptima is an equal employment opportunity employer and makes all employment decisions on the basis of merit. CalOptima wants to have qualified employees in every job position. CalOptima prohibits unlawful discrimination against any employee, or applicant for employment, based on race, religion/religious creed, color, national origin, ancestry, mental or physical disability, medical condition, genetic information, marital status, sex, sex stereotype, gender, gender identity, gender expression, transitioning status, age, sexual orientation, immigration status, military status as a disabled veteran, or veteran of the Vietnam era, or any other consideration made unlawful by federal, state, or local laws. CalOptima also prohibits unlawful discrimination based on the perception that anyone has any of those characteristics or is associated with a person who has, or is perceived as having, any of those characteristics.

If you are a qualified individual with a disability or a disabled veteran, you may request a reasonable accommodation if you are unable or limited in your ability to access job openings or apply for a job on this site as a result of your disability. You can request reasonable accommodations by contacting Human Resources Disability Management at 657-900-1134.

Keywords: CalOptima, Orange , Supervisor, Population Health Management (Quality Initiatives), Other , Orange, California

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