Student Veterans of America Jobs

This job was posted by https://idahoworks.gov : For more information, please see: https://idahoworks.gov/jobs/2198994 Looking for a way to make an impact and help people?

Join PacificSource and help our members access quality, affordable care!

PacificSource is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to status as a protected veteran or a qualified individual with a disability, or other protected status, such as race, religion, color, national origin, sex, sexual orientation, gender identity or age.

Diversity and Inclusion: PacificSource values the diversity of the people we hire and serve. We are committed to creating a diverse environment and fostering a workplace in which individual differences are appreciated, respected and responded to in ways that fully develop and utilize each person\'s talents and strengths.

This position will take lead role the development and implementation of multi-year Care Management (CM) transformation and improvement plan in service to the out Population Health vision. This position will work closely with the CM Director as well as internal and external stakeholders (including, but not limited to, key internal teams such as Population Health, Quality Improvement, Provider Network, Compliance and Medicare/Medicaid Administration, along with providers and community partners) to develop and lead CM initiatives in accordance with CMS, OHA and NCQA requirements. This includes pursuing goals to identify evidence based best practice and elevate/scale/operationalize a standardized integrated (physical health, behavioral health, oral health) CM approach across lines of business and regions. This role requires strong and effective relationships to lead multi-stakeholder strategic planning efforts, as well as strong execution skills in order to effectuate internal and/or external work plans.

Essential Responsibilities:

• Serve as a Care Management subject matter expert and effectively share expertise with internal stakeholders including, but not limited to Compliance, Quality Improvement, Population Health, and Provider Network.
• Maintain knowledge and expertise in CMS and OHA regulatory requirements. Act as primary audit contact for CMS and OHA.
• Represent the company across regions as subject matter expert and Care Management compliance and regulatory leader across Government Lines of Business\'s (LOB\'s).
• Serve as a key subject matter expert for integrating additional regulatory/compliance requirements by identifying strategies, leading teams to build necessary work flows and ensuring required reporting capabilities are met.
• Accountable for ensuring compliance to federal and state regulatory requirements related to Care Management across line of business, including activities performed within PacificSource and in conjunction with critical community providers.
• Accountable for strategic development, implementation and oversight of a multi-year Government transformation and improvement strategy by leading efforts in collaboration with internal and external stakeholders such Population Health, Quality Improvement, Behavioral Health, Compliance and Provider Network along with providers and community partners.
• Collaborate and support additional population health, clinical quality outcomes and future business opportunities to effectuate Care Management transformation strategies including new and emerging opportunities for expanded programming and services.
• In conjunction with other subject matter experts, develop and deploy components of workforce plans, health equity plans, training plans, Transformation and Quality Strategy initiatives, and quality improvement initiatives.
• Demonstrates strong analytical skills and ability to suc essfully collaborate with analytics to establish process, outcome and value metrics for clinics in integrated system of care in primary and specialty behavioral health.
• Demonstrate ability to successfully navigate in a matrixed organization, a history of executing in a fast-paced environment, and ability to remain accountable for deliverables while working in partnership with others throughout the organization.
• Analyze and interpret data in collaboration with other departments to identify population health cost savings and care improvement opportunities across the continuum of care and make recommendations for innovative initiatives and integrated health strategies with provider partners.
• Actively participate in various internal and external committees in order to provide care management expertise, disseminate information, and promote BH transformation and improvement strategies.
• Coordinate with other departments to understand and deploy needed CM clinical strategies as dictated by evidence-based criteria, legislation and parity needed.
• Demonstrate strong communication skills (verbal and written) to ensure effective relationships and follow through.
• Utilize Lean methodologies to identify process improvement and cultivate a culture of continuous improvement.

Supporting Responsibilities:

Work with department leadership in responding to inquiries or com