Director - Government Quality Programs

JOB PURPOSE:
Position is responsible for supporting the strategic direction and ongoing operations of government value-based program initiatives across Piedmont Healthcare. This role supports programs spanning the hospital and physician side of the company. The director remains current on changes in reporting requirements for Medicare programs to include but not limited to QNET, HACs, PSIs, MSSP, and Medicare Advantage (MA) plans.

KEY RESPONSIBILITIES:
1. Manage value-based government programs across all care settings (both inpatient and ambulatory)
2. Serve as Piedmonts internal subject matter expert on regulatory requirements applicable to required or voluntary value-based programs
3. Facilitation of integration of new strategies for value-based programs across the inpatient and ambulatory settings
o Explore and identify evidence-based solutions related to value-based programs. Create and support multi-disciplinary project teams to advance product offerings related to population health services
Responsible for working with Value-Based Care team, Managed Care, and executive leadership in determining most appropriate pilot initiatives that align with Piedmont Healthcare system goals related to specific value-based programs
Responsible for ensuring successful spread of selected initiatives across the organization
4. Lead pilot initiatives and work closely with stakeholders from across Piedmont Healthcare to support transition of selected pilots to long term ownership within the operational teams delivering care related to care of value-based program populations
Manage relationships with respective lead vendors and partners as it relates to value-based programs
5. Design and monitor the following data analytics and metrics related to management of select value-based programs
Data analytics and recommendations to leadership as it relates to the value-based program strategy
Monthly reporting at system level to assess trends, best practices and gaps in relation to value-based programs and make recommendations for program changes and/or strategies based on data analytics and trends
6. Work with the government and/or payors to ensure all program requirements met for ACO participation
7. Collaborate with compliance and operations to successfully meet all program requirements
8. Ensure data collection and submission efforts to external reporting groups are successful
9. Lead operationalization of Medicare Shared Savings Program for Piedmont Clinic providers
o Collaborate with compliance and Clinic Operations to successfully meet the Medicare Shared Savings Program ACO requirements
o Lead data collection and submission efforts to CMS
o Develop communications strategy for Piedmont Clinic providers related to MSSP
o Work with CMS to ensure that all participants have met CMS requirements
10. Serve as point person from Value-Based Care team for Medicare Advantage program strategy and operations
11. Serve as subject matter expert for organization as related to value-based programs
12. Integrate new Piedmont entities and physicians into value-based programs (e.g. Medicare Shared Savings Program participation)

MINIMUM EDUCATION REQUIRED:
Bachelors degree in business, public health or related field
MINIMUM EXPERIENCE REQUIRED:
Seven (7) years of professional experience in strategy, program/project management, healthcare operations, to include three (3) years of leadership experience.
MINIMUM LICENSURE/CERTIFICATION REQUIRED BY LAW:
None
ADDITIONAL QUALIFICATIONS:
Masters degree preferred