Manager, Population Health
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Job Description
Population health manager leading CareSource’s quality, care navigation, analytics, and community engagement strategies for Georgia members. Managing staff and mobile field operations.
Responsibilities:
- Lead and manage population health strategies to improve quality of care, access, and outcomes for CareSource members
- Implement and manage the population health management strategic plan for the market with the Director of Population Health and Chief Medical Officer
- Manage team care navigation efforts connecting members with resources, services, and supports
- Support quality improvement initiatives and drive gap closure with Enterprise Quality Improvement teams
- Implement quality initiatives and interventions for women, children, pregnant women, infants, adolescents, and teens
- Review, audit, and monitor quality improvement, performance improvement, and accreditation activities
- Develop and implement community and provider engagement strategies with Network and Community Marketing teams
- Support community partnerships addressing health equity and social determinants of health barriers
- Use analytics and data to drive community, provider, and member engagement
- Participate in root cause analyses and ensure data is effectively presented and used to address accreditation, clinical monitoring, and quality issues
- Establish and maintain standards and procedures for accreditation and quality reporting and documentation
- Communicate strengths and improvement opportunities to the Quality Management and Improvement Committee
- Participate in national, state, and local committees, focus groups, and internal workgroups
- Provide leadership, direction, coaching, and development to staff
- Monitor staff performance, scheduling, productivity, and quality
- Perform other job-related duties as requested
- Travel regularly to homes, offices, and other public settings; travel may exceed 50%
Requirements:
- Must reside in the State of Georgia and same assigned territory, except possible business-need exceptions
- Bachelor of Science (B.S.) in a health-related field required
- Equivalent years of relevant work experience may be accepted in lieu of required education
- Three (3) years in a Managed Care Organization (MCO) or other healthcare-related field required
- Three (3) years of experience in quality or analytics required
- Proficiency in Microsoft Office Suite, including Word, Excel, and PowerPoint
- Experience in data collection, analysis, and trending of processes and outcomes
- Knowledge of performance improvement principles, quality methodology, regulations, and standards for health plan quality and accreditation requirements
- Working knowledge of health plan policies and procedures
- Current, unrestricted Registered Nurse (RN) licensure in state of practice preferred
- Influenza vaccination required during influenza season, with annual proof for designated positions
- Ability to travel more than 50% of the time; over 50% routine mobile travel required
- Ability to work flexible hours, including possible evenings and weekends
- Master's degree in health services, public health, health care administration, or another health care field preferred
- Additional two years in an MCO or healthcare-related field strongly preferred
- Three years of leadership/management experience preferred
- Medicaid experience preferred
- Ability to present data and recommendations clearly and concisely
- Effective problem-solving, critical thinking, listening, communication, interpersonal, teamwork, and organizational skills
- Ability to work independently and in a team environment
- Customer service and member-focused orientation
Benefits:
- Bonus tied to company and individual performance may be available
- Comprehensive total rewards package
- Influenza vaccination requirement and immunization support for designated positions
- Reasonable accommodations for qualified individuals with disabilities, medical conditions, or sincerely held religious beliefs
- Flexible hours, including possible evenings and/or weekends as needed
- Continuing education support
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