Senior Population Management Advisor AdventHealth Corporate
Location Address: 101 Southhall Lane Maitland, FL 32751
Top Reasons To Work At AdventHealth Corporate
Immediate Health Insurance Coverage
Career growth and advancement potential
You Will Be Responsible For:
Regular Rounding to communicate messages on behalf of the PHSO, Provider Network, or health plans about the value of solutions, strategies, performance/incentive models, policies, procedures and to ensure timely issue resolution.
On boarding providers for Provider Networks and affiliated payer networks/health plans to ensure provider is informed and engaged related to essential information.
Facilitates practice change management in regards to emerging trends related to population health initiatives, reimbursement models, patient satisfaction, customer outreach, panel growth, and provider performance with quality and efficiency metrics. The Advisor educates and consults providers in regard to regional-specific quality and clinical improvement initiatives including Clinical Documentation Integrity, HCC recapture and HEDIS care gap closure. The Advisor should be seen as an asset to their practices by providing important information and recommended enhancements to help ensure success in the coming value-based healthcare environment.
Responsible for promoting and facilitating provider recruitment and presenting the value of participation with the network to small and large groups, in formal and informal settings.
Actively participates in continuing education topics for other Population Health Advisors. Suggests topics or items based on conversations occurring in the field or based on other perceived gaps in education.
Responsible for tracking, measuring, analyzing, and reporting on provider contacts, updating provider demographics, validating provider contact information, and reporting issues in the designated provider reporting tool.
Strategically identifying providers necessary to fulfill network adequacy needs for the provider networks. This includes identifying specific network gaps by health plan/product and line-of business.
Works seamlessly, effectively, and in harmony with all internal teams including, but not limited to, PHSO credentialing, experience center, quality and care integration, provider engagement education, analytics, and finance to ensure integrated operations that result in a superior consumer experience for the provider.
What You Will Need:
Bachelor's Degree in healthcare, business or a related field
4+ years' experience in performance improvement, operations, marketing or in a relevant physician/ hospital/ managed care environment
4+ years' experience working collegially with physicians
Significant knowledge of hospital and provider (multi-specialty group, IPA or PHO) operations and services impacted by managed care and health care reform
Significant knowledge about the quality, clinical and financial aspects of managed care, including capitation and global budgets
Significant knowledge about CDI, RAF, and HEDIS
Provide Population Health subject matter expertise, consultation and education to network providers (market/region dependent) by establishing and maintaining a strong relationship with the provider and practice. Regional Senior Population Management Advisors are expected to make regular visits to provider practice offices, with the intent to advise and educate on a wide variety of topics (examples include population health management strategies and programs, clinical integration, incentive program(s), provider web site, quality and clinical performance improvement initiatives which are region-specific, and Population Health Services Organization (PHSO) and provider network policies and procedures). Hierarchal Condition Code (HCC) usage and recapture, Risk Adjustment Factor (RAF) and HEDIS care gap consultation are important aspects of the Senior Population Management Advisor (Advisor)'s role.
The Advisor is a highly strategic role within the PHSO, designed to provide value to the network provider and practice through expertise, consultation, change management, and provider engagement. The Senior Population Management Advisor is the relationship manager for the practice and exists to help simplify the provider's experience with the PHSO, Provider Network, and affiliated payer networks/health plans while working to identify and address improvement opportunities. As part of the PHSO Team, the Advisor will be responsible for executing plans and delivering key messages to providers and office staff. This position is field-based with the majority of time spent in provider offices. Senior level articulates complex topics for understanding; identifies, promotes and facilities provider recruitment and participation; team leader.
This facility is an equal opportunity employer and complies with federal, state and local anti-discrimination laws, regulations and ordinances.
Adventist Health System