Job Information
Martin's Point Health Care Manager Population Health & Quality in Portland, Maine
Join Martin's Point Health Care - an innovative, not-for-profit health care organization offering care and coverage to the people of Maine and beyond. As a joined force of "people caring for people," Martin's Point employees are on a mission to transform our health care system while creating a healthier community. Martin's Point employees enjoy an organizational culture of trust and respect, where our values - taking care of ourselves and others, continuous learning, helping each other, and having fun - are brought to life every day. Join us and find out for yourself why Martin's Point has been certified as a "Great Place to Work" since 2015.
Position Summary
The Manager position is responsible for the day-to-day operations of the Population Health programs and clinical quality programs within the Delivery System. The position will provide direct supervision of the Population Health Nurses (PHNs) and Clinical Quality Specialist (CQS) Nurses. PHN interventions are patient-centered and focus on problem-solving that supports patient well-being, care team efficiency, and optimal use of payer and community-based resources. CQS responsibilities include a programmatic and systems approach to managing quality within the Delivery System. The Manager ensures all Population Health and quality work is aligned with the goals of the Delivery System.
The Manager works closely with all members of the Quality and Risk Team as well as other teams including Health Plan Operations, Delivery System staff and providers, and Support staff, including the Health Management Department, Member Services, Informatics, Marketing, Coding and Billing, Health Information Management, and Business Process Improvement. The Manager also collaborates with community-based providers to build strong linkages supporting patient access to services. Additionally, the manager engages with payers to meet contractual obligations related to quality performance and care management activities. The Manager will ensure that processes and staff comply with applicable regulatory and accrediting body standards (i.e. American Nurses Association (ANA), Case Management Society of America (CMSA), and the National Committee for Quality Assurance (NCQA).
Job Description
Key Outcomes:
Manages the day-to-day Population Health operations, including but not limited to the standard work in practice setting, clinical auditing, care management, population assessment and stratification.
Ensures that care management programs are aligned with current industry evidence-based practice as well as local, national, and regulatory compliance standards.
Initiates, defines, and provides ongoing monitoring relative to PHN Standard Work in practice locations.
Creates a strong linkage between Care Management, Population Health, and Clinical Quality work to drive efficiencies and higher quality and lower cost care for our patients.
Partners with Practice Medical Directors (PMDs) to help redefine, expand and maintain Care Management efforts within the Delivery System.
Responsible for performance on the Delivery System’s clinical programs tied to contractual performance, including but not limited to Medicare MIPS and other Value Based Contracts (VBC) with payors.
Supports the Delivery System with the development and oversight of clinical care pathways for patients with chronic conditions (i.e. COPD, DM)
Initiates, defines, and analyzes target populations for programs. Performs ongoing measurement of outcomes, modifies programs to continue to improve performance.
Participates in technology and system planning and enhancement; recommends and tracks technology modifications that support population health initiatives.
Regularly monitors team capacity and demand and adjusts work and resources as necessary. Manages employees consistent with HR policies and procedures to ensure productivity, performance and quality management metrics and outcomes . Ensures staff have all required resources necessary to effectively perform assigned duties.
Identifies opportunities for process improvement and initiates or delegates projects.
Ensures compliance with and integrity of all departmental processes and policies with contractual, regulatory and accreditation requirements
Provides expertise in psychosocial care models including palliative care and hospice to team and patients
Education/Experience:
BS Degree in Nursing required
5+ years of nursing experience in Population Health Management, Quality, and/or experience in Case Management, Disease Management and Utilization Management preferred
Demonstrated leadership/management experience
License/Certification:
Licensed as an RN in Maine and other appropriate jurisdictions as necessary
CCM preferred
Skills/Knowledge/Competencies (Behaviors):
Demonstrated ability to manage, organize and prioritize workload in a timely accurate manner.
Demonstrated analytical and critical thinking skills to develop programs to help reduce ED utilization and decrease hospital admissions/readmissions.
Demonstrated ability to develop and manage matrix teams to effective results.
Knowledge of industry standards and innovative approaches to Population Health Management for ensuring high quality collaborative care, effective medical costs, and service
Demonstrated knowledge and experience using care management clinical systems and phone system technology.
Demonstrated analytical knowledge and ability to assess performance against metrics.
Demonstrated interpersonal, communications, operational, team building, and quality improvement skills.
Excellent interpersonal, verbal, and written communication skills
Critical thinking: can identify root causes and implement creative solutions
Ability to prioritize and manage multiple competing demands and to function independently
Computer proficiency in Microsoft Office products including Teams, Word, Excel, and Outlook
Strong management and leadership skills
Demonstrates an understanding of and alignment with Martin’s Point Values.
We are an equal opportunity/affirmative action employer.
Do you have a question about careers at Martin’s Point Health Care? Contact us at: jobinquiries@martinspoint.org
Martin’s Point Health Care is a progressive, not-for-profit organization providing care and coverage to the people of Maine and beyond. The organization operates six primary care health care centers in Maine and New Hampshire, accepting most major insurance plans. Martin’s Point also administers two health plans: Generations Advantage (Medicare Advantage plans available throughout Maine and New Hampshire), and the US Family Health Plan (TRICARE Prime® plan for active-duty and retired military families in northern New England, upstate New York, and western Pennsylvania). For more information, visit https://careers.martinspoint.org .
