SUMMARY: Experienced and proactive individual to fill the position of Manager. In this role, you will lead a team of Practice Transformation Specialists, driving the implementation and transformation of value-based healthcare processes. Reporting directly to the Director of Value-Based Care, you will play a vital role in coaching practices, enhancing patient outcomes, and fostering a culture of continuous improvement related to HEDIS/STARs, Risk Adjustment, and Practice Management. Reports to: Director, Value Based Care Location: Houston, TX EDUCATION: • Bachelor's Degree in related field or five (5) years related experience • Master’s Degree preferred LICENSES/CERTIFICATIONS: A license in one of the following is preferred: • Certified Risk Adjustment Coder (CRC) • Certified Professional Coder (CPC) • Certified Professional in Healthcare Quality (CPHQ) • Licensed Vocational Nurse (LVN) • Registered Nurse (RN) EXPERIENCE: • Minimum five (5) years of experience with value-based care arrangements required • Minimum five (5) years of experience with a focus on EMR operations, use, design, and implementation • Minimum three (3) years Risk Adjustment experience required • Minimum three (3) years of healthcare experience with an understanding of physician needs and practice workflow • Minimum five (5) years of medical practice management, clinical program development, clinical transformation, health care quality analytics and/or quality improvement • Minimum five (5) years of experience in team management, coaching teams to drive transformative initiatives • Minimum three (3) years of provider facing experience required • Knowledge of CMS STAR Ratings Program requirements required • Knowledge of Risk Adjustment required • Knowledge of HEDIS and NCQA requirements • Strong communication and presentation skills required • Interpersonal skills necessary in order to interact effectively and build strong relationships with physicians, staff and all levels of management • Computer proficiency required SKILLS: • Knowledge of healthcare delivery • Ability to work in a fast paced environment with changing priorities • Ability to work with others in a matrixed environment • Demonstrated written communication skills • Demonstrated time management and priority setting skills • Demonstrated problem solving skills • Demonstrated organizational skills • Demonstrated ability to converse and collaborate with physicians and other healthcare personnel • Ability to interpret and utilize clinical data analytics to formulate data driven health care strategies RESPONSIBILITIES: The primary responsibilities of the Manager, Practice Transformation include managing the Practice Transformation team in completing the following: Establish a planned care model with practices in integrating administrative, financial, and clinical systems for better performance and improved outcomes. Utilize available tools to assist clinicians with capturing and analyzing population‐based data to support practices with data‐driven decision making and direct improvement efforts to support practice leadership develop the skills to interpret and act on quality metric data with performance management tactics. Facilitate the efforts around care coordination utilizing population health management tools for identifying and stratifying patient risk and enhance patient engagement to increase self‐ management capacity. Creates and utilizes established education and clinical pathways to support comprehensive and consistent disease management education to close patients care gaps. Build trusting relationships to help drive continuous change. Prepare practices to continue the transformative activities that demonstrate consistent improvement on performance and quality measures. Understand Health Information Technology (HIT) and its role in improving healthcare outcomes. Understand the role of analytics and the importance of clear, defined, and accurate data for improving healthcare outcomes. Execute responsibilities in a manner that promotes collegial, collaborative, and effective communication to successfully reach mutually agreed upon goals with practice sites and colleagues. Provide support for other interdisciplinary teams (e.g. s clinical implementation, analysis, research, support services, training). Educates providers and supports provider practice sites regarding the National Committee for Quality Assurance (NCQA) HEDIS measures and risk adjustment. Serve as a liaison to practices, providing on-site and remote assistance and facilitation to the clinicians, care teams and their associated practices to drive improvement in clinical quality, risk adjustment and operational efficiency. Develop and implement workflow design and redesign, including electronic health record (EHR) optimization, clinical documentation, billing practices, assessments, financial analyses, and financial performance improvement and reporting. Develop and implement changes to root causes of financial and quality under performance and communicate strategies to providers and provider groups. Review and interpret summary data and performance reports related to Risk Adjustment and HEDIS/STARs and to develop data driven provider performance strategies. Actively participate in cross-functional teams to conduct work and resolve enterprise and regional issues. Identifies provider specific metrics and coaches providers on care gap closure opportunities. Provide support to address specific practice needs. Collaborates with Quality, Risk Adjustment and Operations to improve provider performance. Partners with physicians/physician staff to find ways to encourage member clinical participation in wellness and education by providing resources and educational opportunities to provider and staff. Functions as HEDIS subject matter expert in consultation with provider practices by conducting internal audits for provider compliance with regulatory and NCQA accreditation standards, and monitoring and providing consultation to departments to correct deficiencies. Functions as Risk Adjustment subject matter expert in consultation with provider practices by conducting concurrent reviews for provider compliance with regulatory and clinical/coding documentation standards, and monitoring and providing consultation to departments to correct deficiencies. Drives implementation of market specific strategies that improve member outcomes. TECHNICAL SKILLS: • Working knowledge of Microsoft Office • Working knowledge of Electronic Health Records (EHR) • Proficiency in Microsoft Office Professional products, including Visio and PowerPoint. • Detail-oriented, highly organized, and committed to quality. • Ability to prioritize workload effectively and work on simultaneous projects with competing priorities. • Strong problem-solving skills and the ability to use data to drive change.