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Job description
Position Summary
Position Summary
This position works under the supervision of the Executive Clinician to oversee all activities related to P4P and care coordination. The Pay for Performance and Care Coordination Manager will work collaboratively with the Quality Manager to coordinate Network initiates related to pay-for-performance (P4P) and care gap closure incentives. Along with maintaining the P4P tracking system and leading the P4P committee, the P4P and Care Coordination manager will collaborate with the Executive Team to identify incentive benchmarks, measuring outcomes against benchmarks, and providing feedback that promotes performance improvement education and development.
Ideal Candidate:
- extensive knowledge in Quality Improvement and P4P activities: HEDIS measures, UDS measures, CQI
- have experience in health informatics: ICD-10 & CPT II coding, data analysis
- supervisory experience
Those who have the following background are encouraged to apply:
- extensive knowledge in Quality Improvement and P4P activities: HEDIS measures, UDS measures, CQI
- have experience in health informatics: ICD-10 & CPT II coding, data analysis
- supervisory experience
Those who have the following background are encouraged to apply:
Health Informatics Nurse
HEDIS Nurse
Health Information Manager (HIM)
Quality Improvement Manager
General Duties
1. Maintain an in-depth level of understanding how data are captured within the
EHR, i2i, reports and other databases in order to assist with end users for reporting and analysis of data
2. Conducts analyses using internal and external data sources to evaluate, identify,
and prioritize opportunities for performance improvement
3. Remains updated and communicates changes/updates related to performance
improvement programs and measures
4. Track HEDIS measures that FPCN actively reports, make recommendations for
5. measures to be added to workflow and reporting Oversees and coordinates
quarterly payor meetings
6. Track national recognition programs and make recommendations for
participation (ex., Diabetes Recognition Program, Million Hearts, etc.)
7. Perform regular gap analysis for all payor’s CQMs to prioritize workflow improvement interventions
8. Work with Health Informatics Manager and Revenue Cycle Team to maintain coding integrity
9. Work with Accountable Care Organization (ACO) on care coordination efforts
P4P Program
10. Responsible for tracking P4P payer incentives for all clinical disciplines
11. Actively seeks payor updates on P4P incentive and measure reporting
opportunities
12. Report regularly on performance measures
13. Coordinate monthly P4P committee meetings; engages departmental leadership
around P4P initiatives and provides resources to reach benchmarks
Care Coordination
14. Manage the FPCN Care Coordination program and staff.
15. Responsible for tracking of Care Coordination program. Actively retrieves Care
Gap reports from payors, distributes panels to appropriate staff. Works with Quality Manager to create, track and maintain Care Coordination reports in i2i.
16. Collaborates with the Care Coordinators and Care Managers at each site to
ensure care coordination activities align with quality improvement measures,
initiatives, and national/ state standards.
17. Identify gaps in care of FPCN primary care patients and collaborate with the
Executive Clinician and Department Directors to develop network and site
strategies to amend. Delegate tasks to Care Coordinators as appropriate for
patient recall.
Qualifications
· Understanding of healthcare environment through 3-5 years professional experience in a health or human services setting; 3+ years in outpatient setting, preferred
· Health insurance experience, preferred
· Healthcare reimbursement experience required
· Extensive knowledge of ICD-10 coding, CPT II coding, and HEDIS measure reporting
· Data analysis and/or statistical background knowledge required
· CPC or CCS or comparable certification at or within 1 year of hire date
· Strong analytical capabilities and problem-solving skills to analyze and validate data
· Supervisory experience required
· Able to work independently
Vaccine Mandate:
FPCN, a program in the City of Philadelphia, are required to follow the COVID vaccine mandate for healthcare workers per Philadelphia Department of Public Health. FPCN requires Healthcare Workers to be fully vaccinated. Fully vaccinated means it has been two weeks since the final dose of vaccine. Thus, we require vaccination prior to start for all new hires. This currently does not include boosters.
EEO
Resources for Human Development is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, age, religion, gender, gender identity, sexual orientation, national origin, genetic information, and veteran or disability status.
