Quality Practice Manager (QPM) Las Cruces Physician Services

Memorial Physician Practices consist of 8 primary care-based clinics and 15 Clinicians including a Family Residence program. In 2019 and 2020, insurance payers have been establishing databases and collecting quality data on MPP providers to position and leverage MPP towards quality-based contracts. In 2021, MPP will proactively work with insurance payers such as UHC, Presbyterian, BCBS, Western Sky and Humana to maximize quality incentive programs. In addition to quality incentive dollars, the implementation of MPP will increase volumes in PCP visits, colonoscopies, cervical cancer screenings, and mammograms.

The Quality Practice Manager (QPM) will collaborate with employed practices to achieve local objectives for Memorial Medical Practices through ongoing education, training, and support activities. The QPM establishes and maintains practice/provider relationships, presenting, practices HEDIS, STARS, and RAF training and planning, and contract performance monitoring with the ultimate goal of optimizing practice performance in a value-based and/or risk-based environment.

This position collaborates with Credentialing, Care Management, technology platform, and payer representatives as appropriate.

Responsibilities:

Collaborate with various practices and departmental leaders to accomplish workload requirements.

Support activities to achieve the overall strategy and objectives of the Practice Performance department.

Serve as the primary point of contact and conduit for all other subject matter experts that need to interface with the practice and its staff.

Responsible for developing and strengthening relationships with various provider groups, while serving as the primary contact for the assigned providers and practices. 

Onboarding Education and Training.

Payer contract offerings.

Strategic network communication.

Performance reports and scorecards Implementation of Equality Health technology.

Introduction to other Equality Health teams as appropriate.

Work closely with Practice Managers, Directors, and Executive team to identify provider issues and escalate to develop and implement a course of action for resolution.

Responsible for accurate documentation and maintenance of provider information within electronic medical record.

Ensure the collection and maintenance of contracts and provider and practice information.

Identify opportunities for process improvement and facilitate issue resolution Identify and provide recommendations for provider participant’s quality and utilization improvement plans and assist practices in the development, implementation, monitoring, and tracking of contract goals and activities.

Monitor the overall performance of the practice and its providers to ensure that there is compliance.

Deliver operational reports (scorecards) to the practice/providers and initiate one-on-one meaningful interactions regarding current performance.

Utilize professional, clinical and/or quality improvement experience and expertise to guide the practice.

Support new business growth by helping to identify opportunities for developing primary care provider and/or specialist leads to close gaps in network services and access.

Perform other responsibilities as assigned for special projects and escalated issues.

Demonstrated understanding of risk and value-based contracting.

Demonstrated knowledge and experience with primary health care practice standards and quality performance measures– STARS and HEDIS.

Excellent verbal, written and interpersonal communication skills; highly collaborative team approach to work.

Proficiency with Microsoft Office applications and web-based technologies Strong provider relations skills and experience.

Familiar with payment alternatives such as fee for service, capitation, global budget, performance compensation and episode of care payment Familiar with patient and practice risk adjustment mechanics and premium-based payment methodologies.

Familiar with patient and practice risk adjustment mechanics, APR; HCC/RAF Familiar with conventional payment methodologies (CMS-RBRVS).

Experience with database management in a healthcare setting Demonstrated ability to gain acceptance and compliance from provider and staff and achieve a mutually beneficial outcome.

Excellent problem-solving skills, including the ability to systematically analyze problems, draw relevant conclusions and devise appropriate courses of action.

Able to convey complex or technical information in a manner that others can understand, and able to understand and interpret complex information from others.

Successful record of managing multiple projects with demonstrated ability to work independently in rapidly changing environments.

• • Minimum Education: High School Diploma or equivalent required. Bachelor’s degree in Business, Healthcare Administration or related field of study; or, an equivalent combination of education and/or experience.
  • Minimum Experience: Three (3) years of experience in the healthcare industry; preferably with healthcare network operations and/or practice management.