Manager, Population Health Programs

Job Description

The Manager of Population Health Programs (PHP) is responsible for managing, organizing, and coordinating Prospect’s Population Health Program activities. An in-depth understanding of managed care, Medicare and Medicaid regulations, Model of Care and NCQA Population Health requirements are necessary. The Manager of PHP will have staff oversight including supervisors, case managers, care coordinators, health educators, and social workers. Other duties include but are not limited to: staff hiring and retention, performance management, reviewing or gathering of data to promote performance improvement, health plan reporting, and participation in or facilitation of meetings or projects related to departmental functions.

Responsibilities

To perform this job successfully, an individual must be able to perform the job description satisfactorily. This job description reflects management's assignment of essential functions, it does not prescribe or restrict the tasks that may be assigned. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• Knowledge of HIPAA regulations preferred
• Excellent written and verbal communication skills (50 WPM)
• Exceptional customer service and conflict resolution skills
• Must be able to work independently.
• Ability to multi-task, prioritize, and work in a fast-paced environment
• Must be proficient in Microsoft Office navigation, Excel, Outlook, Teams and Word and/or IDX knowledge.
  
  

Duties:

• Manages Population Health Program areas including organizing and executing Population Health activities aimed to improve delivery of clinical services needs within Prospect Medical Systems, as well as government and regulatory requirements.
• Continuously evaluates data outcomes, identifying alternatives, preventing unnecessary costs and services while ensuring quality care, and patient satisfaction.
• Performs Supervisory audits as necessary to ensure compliance with all external and internal Population Health requirements and ensures the quality of care provided to members/beneficiaries.
• Assists with the development and implementation of departmental policies and procedures.
• Hires, trains, coaches, counsels, and evaluates their performance of direct reports.
• Improves on the effectiveness and efficiency of PHP staff, through process improvements activities.
• Provides leadership and supervision to supervisors, case managers, health educators, social workers, and care coordinators.
• Oversees all Health Plan reporting completions and submissions in a timely manner.
• Participates in interdepartmental and cross-functional meeting as needed. Serves as a liaison and resource between Population Health Program and other departments across the organization.
• Other duties as assigned by Senior Director.
  
  

Qualifications

Required Education:

• RN unrestricted active license required.
• Knowledgeable in managed care, Medicare, Medicaid regulations, Model of Care and NCQA Population Health requirements.
  
  

Preferred Education :

• Bachelor’s Degree of Science in Nursing and other related fields or higher preferred
• 2+ years of Population Health and/or Disease Management or other similar programs experience in managed care required.
• Strong leadership skills with the ability to influence, manage, and motivate personnel.
• Must have analytical ability for problem identification and assessment and evaluation of data/statistics obtained from an on-going review process.
• Capable of resolving escalated issues arising from operations and requiring coordination with other departments.
• Ability to prioritize and multi-task
• Able to work independently and make independent clinical and non-clinical decisions
• Excellent communication skills
• Maintain professional attitude when working with internal and external customers
• Adeptly utilize computer programs – both Microsoft Office applications and job-specific electronic software applications
• Maintain and ensure confidentiality of patient information
  
  

Preferred Experience:

• 3+ years demonstrated leadership and team management/development skills preferred.
• Experience in health plan audits and compliance is a plus.
  
  

About Us

With approximately 9,000 physicians to serve our 260,000 members, Prospect Medical Systems is proud to be among the most innovative medical systems in California, Texas and Rhode Island. Our extensive care services range from primary care and specialty physician services to acute care hospital and skilled nursing facilities to behavioral health and wellness services. Each of our Independent Physician Associations (IPAs) and networks support the use of advanced diagnostic and treatment tools to provide our members with convenient access to state-of-the-art healthcare. For 25+ years, Prospect Medical has been focused on our mission of supporting independent physicians where, through risk arrangements, we work closely together with health plans, facilities and healthcare physicians for the benefit of every person who comes to us for care. We provide quality healthcare services that are designed to offer our patients highly coordinated, personalized care and that help them live healthier lives. Prospect Medical Systems manages highly successful IPAs by leveraging our best-practices, results-driven administrative services to manage patients under risk arrangements with health plans/CMS.