Your Future is our Future
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:
Population Health Manager
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).
Job Description:
Position and 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
Experience, Qualifications and Education
- 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
Pay Transparency:
Factors that may be used to determine your actual pay rate include your specific skills, experience, qualifications, location, and comparison to other employees already in this role. In addition to the base salary, certain roles may qualify for a performance-based incentive and/or equity, with eligibility depending on the position. These rewards are based on a combination of company performance and individual achievements.
The hiring range for this position is:
$72,800.00-$97,400.00
Benefits of working at Lumeris
Medical, Vision and Dental Plans
Tax-Advantage Savings Accounts (FSA & HSA)
Life Insurance and Disability Insurance
Paid Time Off (PTO, Sick Time, Paid Leave, Volunteer & Wellness Days)
Employee Assistance Program
401k with company match
Employee Resource Groups
Employee Discount Program
Learning and Development Opportunities
And much more...
Be part of a team that is changing healthcare!
Member Facing Position:
No- Not Member or Patient Facing Position
Location:
Arkansas, Kentucky
Time Type:
Full time
Lumeris and its partners are committed to protecting our high-risk members & prospects when conducting business in-person. All personnel who interact with at-risk members or prospects are required to have completed, at a minimum, the initial series of an approved COVID-19 vaccine. If this role has been identified as member-facing, proof of vaccination will be required as a condition of employment.
Disclaimer:
The job description describes the general nature and level of work being performed by people assigned to this job and is not intended to be an exhaustive list of all responsibilities, duties and skills required. The physical activities, demands and working conditions represent those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individual with disabilities to perform the essential job duties and responsibilities.
Lumeris is an EEO/AA employer M/F/V/D.