Practice Transformation Specialist

Position Summary:
The Practice Transformation Specialist (PTS) is responsible for all value-based care initiatives, interventions to support the implementation and transition to Value Based Healthcare processes. The PTS reports to the Manager, Practice Transformation. The PTS is responsible for providing on-site and remote assistance and /or education to clinicians, care teams and their associated practices to drive improvement in clinical quality, risk adjustment and operational efficiency. The PTS is responsible for partnering with practices and / or health centers and their staff to ensure health plan goals are met as it relates to HEDIS/STARs and Risk Adjustment.

This position coaches a practice staff to improve patient outcomes by developing skills in process improvement, value- based and team‐based care, encouraging patient engagement, and analyzing quality data and measurements. The Practice Transformation Specialist is committed to leveraging Health Information Technology for analytics, quality improvement, research, and practice transformation. The Practice Transformation Specialist will provide guidance and expertise in the development, implementation, and optimization of training materials used to facilitate practice transformation. The Practice Transformation Specialist will work as part of an interdisciplinary team to create and deliver products and services including user education and training materials, project plans, tool kits, and evaluation materials.

Essential Duties and Responsibilities:

• Establish a planned care model with practices in integrating administrative, financial, and clinical systems for better performance and improved outcomes.
• 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.
• 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.
• Educates providers and supports provider practice sites regarding the National Committee for Quality Assurance (NCQA) HEDIS measures and risk adjustment.
• Builds trusting relationships to help drive continuous change 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.
• Prepare practices to continue the transformative activities that demonstrate consistent improvement on performance and quality measures.
• Develop and implement changes to root causes of financial and quality under performance and communicate strategies to providers and provider groups.
• 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, medical record retrieval projects).
• Coach Clinical Practices (75%)
• Provide customized coaching at clinical sites (e.g. PCP, Specialist Practice, Clinical networks) by working with the sites to identify site‐specific needs and opportunities, prioritizing areas of focus, and identifying available and needed resources.
• Coach clinic staff to provide effective ongoing monitoring of performance metrics related to Value based Care (Quality, Risk Adjustment, and MLR).
• Develop a strategic plan to assist with performance improvement at the practices/health center level.
• Guide clinic staff and leadership on the implementation of best practices. Address barriers for effective implementation of improvement processes; propose solutions for practices/health centers to consider in addressing barriers.
• Advise individual clinical sites on the implementation of the interventions and measures, sharing specific best practice examples.
• Encourage practice site leadership to identify existing data sources to minimize the burden of data collection and identify opportunities to efficiently retrieve and collect data to support quality improvement activities.
• Work with practice sites to produce reports on their progress on quality, financial, and utilization goals and share outcomes of quality and clinical measures.
• Works with practice sites on clinical documentation improvement activities, to include chart review, feedback and education.
• Educational Engagement (25%)
• Create or assist in the creation and facilitation of materials and presentations for workshops and conferences; assist with logistical coordination of events.
• Develop and maintain communications such as one-page educational documents, newsletters, and website content.
• Provide support to committees and work groups, such as meeting coordination, facilitation, and follow‐up.
• Present to Apex executive leadership, client leadership, including speaking engagements, and potentially national healthcare projects and conferences.
• New physician training program for practice principles, EHR workflows and clinical standards onsite shadowing and support as needed.

Qualifications:

• Minimum five (3) years of experience with value-based care arrangements required
• Minimum five (3) years of experience with a focus on EMR operations, use, design, and implementation
• Minimum three (2) years Risk Adjustment experience required
• Minimum three (3) years of healthcare experience with an understanding of physician needs and practice workflow
• Minimum five (3) years of medical practice management, clinical program development, clinical transformation, healthcare quality analytics and/or quality improvement
• Minimum five (3) years of experience in team management, coaching teams to drive transformative initiatives
• Minimum three (4) 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
• Proficiency in Microsoft Office Professional products, including Visio and PowerPoint
• Ability to analyze data and use data to drive change

Education/License:

• Bachelors Degree in related field or five (5) years related experience

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)

ABOUT APEX HEALTH SOLUTIONS
Apex Health Solutions powers payers and providers choosing to engage in value-based risk contracting. Apex’s unique solutions create alignment between payers and providers, generating unparalleled value. Combined with Apex’s experienced and successful industry leadership, our focal point remains on improvement in patient quality, satisfaction and overall cost of care. The above job description is not intended to be an all-inclusive list of duties and standards of the position. Incumbents will follow any other instructions, and perform any other related duties, as assigned by their supervisor.