Population Health Manager (Medicare)
Job Summary The Provider Engagement (PE) Advocate is a foundational field-based role within Florida Blue Medicare (FBM), supporting primary care providers (PCP's) as they transition into value- based care and value based payment programs (VBP) which are intended to move our primary care provider partners along a glide path to risk.
Under the direction of the Senior Manager, Provider Engagement, PE Advocate will function as the FBM single point of contact for all VBP and select anchor and preferred provider partners.
The cornerstone of this role is based on providing a concierge level of service and excellence while coordinating resolution, research, provider resource needs, education, FBM internal and external activities with an emphasis on but not limited to clinical operations efficiency.
The PE Advocate is accountable for the relationships with FBM external provider partners and Florida Blue/Florida Blue Medicare internal partners and stakeholders in order to realize quality/HEDIS goals; optimal STARS scores; Risk Adjustment Factor (RAF) coding & accuracy; efficiency improvement; care management/disease management liaison; provider profiling data/report distribution, education, & action items related to clinical transformation; external provider (Provider Link) training; Provider Link key performance indicator monitoring and provider compliance; and resource coordination for provider needs.
The PE Advocate will be responsible for coordinating practice efforts and resources to support care coordination of patients; address social determinants of health needs; support integration of care management functions with Florida Blue/Florida Blue Medicare and provider partners; promote efficiency by supporting adherence to evidence-based medicine; educate on accurate coding and provide performance metrics.
Essential Functions The essential functions listed represent the major duties of this role, additional duties may be assigned Resource Coordination & account management for internal and external partners o FBM single point of contact Concierge level issue resolution for assigned provider partners Evaluation of provider partner needs to align internal resources as needed o Weekly activity reporting o Delivery of Florida Blue Medicare initiatives, materials messaging Quality Improvement and Coding Accuracy o Drive provider performance to enhance Quality Improvement (HEDIS) by partnering with assigned providers to understand gaps in process and workflow or assess additional needs and implement change to enhance clinical transformation and practice optimization o Partner with assigned providers to analyze and improve overall CMS Stars scoring by educating on the CMS Stars program and working within provider teams to enhance / change process protocols while adhering to evidence-based medicine o Review risk adjustment factor for coding accuracy and provide education to drive improvement to enhance patient safety and align the proper care management resources and opportunities Clinical Operations Efficiency and Optimization o Work with assigned provider partners and internal resources to identify opportunities for improvement within overall efficiency and create/drive action plans to implement changes with the goal of efficiency improvement and adherence to evidence based medicine o Liaison with internal and external provider partners and internal resources to facilitate alignment of care management / disease management resources to improve patient outcomes and overall efficiency o Work with internal and external partners to continually identify opportunities and drive clinical transformation efforts and adherence to evidence-based medicine Digital Enablement Ambassador o Provide education and support adoption of external provider platform(s) as a day-to-day workflow in provider offices o Responsible for supporting providers in adhering to FBM VBP key performance indicators (KPI); proactively identify areas of improvement and serve as a feedback loop to internal teams on provider platform issues o Deliver provider provide data/reports and work with internal stakeholders to determine external messaging and best next steps for improvement of identification of best practice to share across provider community Qualifications Required Work Experience 4
years related work experience.
Experience Details:
CMS Stars, HEDIS, Risk Adjustment, Coding Accuracy, Electronic Health Record and Account Management experience working with physician practices and/or health plans.
Required Management Experience No supervisory/management experience required Required Education Related Bachelor's degree or additional related equivalent work experience Additional Required Qualifications Experience in Health or Business Administration, social work, nursing or informatics.
Required Skills:
Excellent communication skills, both oral and written; Understanding of claims and clinical information; Must be able to present an overall professional image for the company; Detail oriented with strong organizational skills; ability to handle multiple tasks simultaneously; Ability to work effectively with little supervision especially while in the field; Must be willing to travel extensively within the Florida Blue Medicare service area and expansion areas.
Additional Preferred Qualifications Provider practice management experience Project management experience preferred LEAN certification Certified Coder Value Based Performance & Contracting General Physical Demands Sedentary work:
Exerting up to 10 pounds of force occasionally to move objects.
Jobs are sedentary if traversing activities are required only occasionally.
Physical/Environmental Activities Must be able to travel to multiple locations for work (i.
e.
travel to attend meetings, events, conferences).
Constantly May be exposed to outdoor weather conditions of cold, heat, wet, and humidity.
Occasionally What We Offer:
As a Florida Blue employee, you will thrive in our Be Well, Work Well, GuideWell culture where being well as an individual, and working well as a team, are both important in serving our members and communities.
To support your wellbeing, comprehensive benefits are offered.
As an employee, you will have access to:
Medical, dental, vision, life and global travel health insurance; Income protection
Benefits:
life insurance, Short- and long-term disability programs; Leave programs to support personal circumstances; Retirement Savings Plan includes employer contribution and employer match; Paid time off, volunteer time off, and 11 holidays Additional voluntary benefits available; and A comprehensive wellness program Employee benefits are designed to align with federal and state employment laws.
Benefits may vary based on the state in which work is performed.
Benefits for intern, part-time and seasonal employees may differ.
To support your financial wellbeing, we offer competitive pay as well as opportunities for incentive or commission compensation.
We also conduct regular annual reviews with pay for performance considerations for base pay increases.
Annualized Salary Range:
$61,000 - $99,100Typical Annualized Hiring Range:
$61,000 - $76,200 Final pay will be determined with consideration of market competitiveness, internal equity, and the job-related knowledge, skills, training, and experience you bring.
We are an Equal Opportunity/Protected Veteran/Disabled Employer committed to creating a diverse, inclusive and equitable culture for our employees and communities.
Recommended Skills Account Management Business Administration Care Coordination Claim Processing Clinical Works Communication Estimated Salary: $20 to $28 per hour based on qualifications.
Under the direction of the Senior Manager, Provider Engagement, PE Advocate will function as the FBM single point of contact for all VBP and select anchor and preferred provider partners.
The cornerstone of this role is based on providing a concierge level of service and excellence while coordinating resolution, research, provider resource needs, education, FBM internal and external activities with an emphasis on but not limited to clinical operations efficiency.
The PE Advocate is accountable for the relationships with FBM external provider partners and Florida Blue/Florida Blue Medicare internal partners and stakeholders in order to realize quality/HEDIS goals; optimal STARS scores; Risk Adjustment Factor (RAF) coding & accuracy; efficiency improvement; care management/disease management liaison; provider profiling data/report distribution, education, & action items related to clinical transformation; external provider (Provider Link) training; Provider Link key performance indicator monitoring and provider compliance; and resource coordination for provider needs.
The PE Advocate will be responsible for coordinating practice efforts and resources to support care coordination of patients; address social determinants of health needs; support integration of care management functions with Florida Blue/Florida Blue Medicare and provider partners; promote efficiency by supporting adherence to evidence-based medicine; educate on accurate coding and provide performance metrics.
Essential Functions The essential functions listed represent the major duties of this role, additional duties may be assigned Resource Coordination & account management for internal and external partners o FBM single point of contact Concierge level issue resolution for assigned provider partners Evaluation of provider partner needs to align internal resources as needed o Weekly activity reporting o Delivery of Florida Blue Medicare initiatives, materials messaging Quality Improvement and Coding Accuracy o Drive provider performance to enhance Quality Improvement (HEDIS) by partnering with assigned providers to understand gaps in process and workflow or assess additional needs and implement change to enhance clinical transformation and practice optimization o Partner with assigned providers to analyze and improve overall CMS Stars scoring by educating on the CMS Stars program and working within provider teams to enhance / change process protocols while adhering to evidence-based medicine o Review risk adjustment factor for coding accuracy and provide education to drive improvement to enhance patient safety and align the proper care management resources and opportunities Clinical Operations Efficiency and Optimization o Work with assigned provider partners and internal resources to identify opportunities for improvement within overall efficiency and create/drive action plans to implement changes with the goal of efficiency improvement and adherence to evidence based medicine o Liaison with internal and external provider partners and internal resources to facilitate alignment of care management / disease management resources to improve patient outcomes and overall efficiency o Work with internal and external partners to continually identify opportunities and drive clinical transformation efforts and adherence to evidence-based medicine Digital Enablement Ambassador o Provide education and support adoption of external provider platform(s) as a day-to-day workflow in provider offices o Responsible for supporting providers in adhering to FBM VBP key performance indicators (KPI); proactively identify areas of improvement and serve as a feedback loop to internal teams on provider platform issues o Deliver provider provide data/reports and work with internal stakeholders to determine external messaging and best next steps for improvement of identification of best practice to share across provider community Qualifications Required Work Experience 4
years related work experience.
Experience Details:
CMS Stars, HEDIS, Risk Adjustment, Coding Accuracy, Electronic Health Record and Account Management experience working with physician practices and/or health plans.
Required Management Experience No supervisory/management experience required Required Education Related Bachelor's degree or additional related equivalent work experience Additional Required Qualifications Experience in Health or Business Administration, social work, nursing or informatics.
Required Skills:
Excellent communication skills, both oral and written; Understanding of claims and clinical information; Must be able to present an overall professional image for the company; Detail oriented with strong organizational skills; ability to handle multiple tasks simultaneously; Ability to work effectively with little supervision especially while in the field; Must be willing to travel extensively within the Florida Blue Medicare service area and expansion areas.
Additional Preferred Qualifications Provider practice management experience Project management experience preferred LEAN certification Certified Coder Value Based Performance & Contracting General Physical Demands Sedentary work:
Exerting up to 10 pounds of force occasionally to move objects.
Jobs are sedentary if traversing activities are required only occasionally.
Physical/Environmental Activities Must be able to travel to multiple locations for work (i.
e.
travel to attend meetings, events, conferences).
Constantly May be exposed to outdoor weather conditions of cold, heat, wet, and humidity.
Occasionally What We Offer:
As a Florida Blue employee, you will thrive in our Be Well, Work Well, GuideWell culture where being well as an individual, and working well as a team, are both important in serving our members and communities.
To support your wellbeing, comprehensive benefits are offered.
As an employee, you will have access to:
Medical, dental, vision, life and global travel health insurance; Income protection
Benefits:
life insurance, Short- and long-term disability programs; Leave programs to support personal circumstances; Retirement Savings Plan includes employer contribution and employer match; Paid time off, volunteer time off, and 11 holidays Additional voluntary benefits available; and A comprehensive wellness program Employee benefits are designed to align with federal and state employment laws.
Benefits may vary based on the state in which work is performed.
Benefits for intern, part-time and seasonal employees may differ.
To support your financial wellbeing, we offer competitive pay as well as opportunities for incentive or commission compensation.
We also conduct regular annual reviews with pay for performance considerations for base pay increases.
Annualized Salary Range:
$61,000 - $99,100Typical Annualized Hiring Range:
$61,000 - $76,200 Final pay will be determined with consideration of market competitiveness, internal equity, and the job-related knowledge, skills, training, and experience you bring.
We are an Equal Opportunity/Protected Veteran/Disabled Employer committed to creating a diverse, inclusive and equitable culture for our employees and communities.
Recommended Skills Account Management Business Administration Care Coordination Claim Processing Clinical Works Communication Estimated Salary: $20 to $28 per hour based on qualifications.
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