Value-Based Care Consultant - Hybrid position - Pittsburgh

GENERAL OVERVIEW: 

This job works collaboratively with participating Clinical Integration Network (CIN) practices and institute stakeholders, regional concierge team and CIN leadership to implement clinical integration and Value-Based Reimbursement (VBR) optimization initiatives by encouraging physicians and care teams to explore the benefits, challenges and opportunities in improving health care outcomes while containing healthcare costs. Develops and implements strategies to promote the principles of value-based, patient-centered care delivery and the goals of the CIN. Serving as a consultant, cultivates in-depth relationships with assigned practices, institutes, and regional partners through in-person meetings and collaboration to set strategic priorities, report results, and identify opportunities for improvement. 
 

ESSENTIAL RESPONSIBILITIES 

• Provide training to assigned practices and/or institutes to utilize and understand CIN cost/utilization reports and use of analytics technology. Perform ongoing in-depth analyses of practice performance reports and other data to identify opportunities, develop practice-specific action plans, and implement strategies to achieve CIN VBR goals.  (25%)
• Within their assigned CIN region, the incumbent, through a consultative role, provide training and foster adoption of optimized workflows, enhanced panel management techniques, improved HER technology utilization, and education on regional quality cost and utilization opportunities, all designed to improve patient access to high-value care, prevent unnecessary episodes of high-cost care, and improve patient outcomes. (25%)
• Work collaboratively with regional operations team and Local Advisory Council (LAC) leaders to develop POD-specific goals and clinical integration strategies. Prepare LAC presentations and provide progress reports based on regional goals. If applicable within assigned region, actively participate in regional quality councils. (10%)
• Perform practice capability assessments and develop comprehensive analysis of findings. (10%)
• Serve as the liaison for care path implementation and care management programs (ECCM) by facilitating introduction and implementation of these services within the practices. (10%)
• Participate in the development and delivery of regional practice manager educational programs, webinars, learning collaborative and dissemination of best practice workflows and strategies. (10%)
• Actively participate and contribute in regional CIN operations meetings, institute leadership meetings, and corporate team meetings. (10%)
•  Other duties as assigned or requested. 

QUALIFICATIONS: 

Required 

• Bachelor’s degree in health-related field or relevant experience and/or education as determined by the company in lieu of bachelor's degree.
• 5 years of population health management principles or related clinical quality or practice operations experience

 
Preferred 

• 1 year of pay for value programs/payer contracts experience.
• 1 year of experience with Patient-Centered Medical Home principles
• PA Registered Nurse license ​

 
Disclaimer: The job description has been designed to indicate the general nature and essential duties and responsibilities of work performed by employees within this job title. It may not contain a comprehensive inventory of all duties, responsibilities, and qualifications required of employees to do this job. 
 
Compliance Requirement: This job adheres to the ethical and legal standards and behavioral expectations as set forth in the code of business conduct and company policies. 

 
As a component of job responsibilities, employees may have access to covered information, cardholder data, or other confidential customer information that must be protected at all times.  In connection with this, all employees must comply with both the Health Insurance Portability Accountability Act of 1996 (HIPAA) as described in the Notice of Privacy Practices and Privacy Policies and Procedures as well as all data security guidelines established within the Company’s Handbook of Privacy Policies and Practices and Information Security Policy.  
 
Furthermore, it is every employee’s responsibility to comply with the company’s Code of Business Conduct. This includes but is not limited to adherence to applicable federal and state laws, rules, and regulations as well as company policies and training requirements.