Practice Performance Manager

Equality Health, LLC is a Phoenix-based whole-health delivery system focused on transforming value-based care delivery with population specific programs that improve access, quality, and member trust. Our mission is to ensure diverse populations receive quality healthcare that improves and enriches their lives. Through an integrated technology and services platform, culturally competent provider network and personalized care model, Equality Health (EQH) helps managed care plans and health systems improve outcomes for diverse populations while simultaneously making the transition to risk-based accountability.

About the Role:

The Practice Performance Manager (PPM) serves as the lead in establishing and supporting a collaborative, innovation-focused relationship with participating practice groups. The goal of this relationship is to optimize Practice Performance in a value-based and/or risk-based environment and assess against industry best practice standards. This individual collaborates internally with the EQH Network Development, Credentialing, Clinical Care, Behavioral Health, Cultural Care and Technology Platform, and externally with payer representatives and community partners. Key activities include:

Responsibilities:

• Leads and manages <25-30 provider group practices with <5000 members or equivalent> in practice transformation activities as outlined in EQH Playbook
• Ensure alignment of practice operations with the key elements of EQH’s Care Model
• Maximize population health outcomes, member experience and provider satisfaction through implementation of EQH’s Practice Transformation Playbook, Pillars of Care, adoption of CareEmpower®, EHR integration and interoperability innovations
• Influence behavior change in practice operations in alignment with industry best practices and key EQH practice transformation modules and resources
• Facilitate Cultural Care, HEDIS, STARS, RAF training, and practice improvement and performance monitoring
• Determine and utilize a regular meeting cadence with assigned practices to ensure progress on practice transformation and improvement activities, as evaluated by improvement in ECIP earnings as well as HEDIS and STARs metrics and other contract goals and value-based activities
• Establish and drive improvement plans measured by cost, quality outcomes and provider satisfaction
• Support activities to achieve the overall strategy and objectives of the Practice Transformation department and assure contractual requirements are met at a practical level
• Serve as the primary point of contact for all other Equality Health subject matter experts that need to interface with the practice and its staff and are self-directed to engage EQH subject matter experts as needed to support practice improvement
• Develop and strengthen relationships with various provider groups and use influence and leadership competencies to help transform the practice toward value-based care
• Assume ownership of the post-recruitment phase of practice cycle and responsibility for project leadership to achieve successful completion, integration, or implementation of:
  • Onboarding
  • Practice assessment, measurement, and tiering
  • Performance Improvement and Practice Transformation Playbook, sharing, interpreting, and actioning data reports and scorecards
  • Education and training
  • Strategic network communication
  • Implementation of EQH product innovations/technology
  • Integration of other EQH teams as appropriate
  • Assess referrals and workflow and support providers in practice transformation
• Utilize professional, clinical and/or quality improvement experience and expertise to guide the practice in transformation
• Deliver operational reports (scorecards) to the practice/providers and utilize data analysis techniques and presentation to convey opportunities for remediation and influence needed practice changes
• Identify operational workflows needing remediation and/or support and presents solutions; elevate as appropriate to EQH leadership collaborators and Executive team as needed to resolve
• Perform other responsibilities as assigned for special projects and escalated issues
• Travel throughout the market service delivery area (SDA), up to 90%, via personal automobile; occasional overnight stays
• Responsible for accurate documentation and maintenance of provider and practice information

Required Knowledge, Education & Experience:

• Bachelor’s degree in Business, Healthcare Administration, or related field of study; or an equivalent combination of education and/or experience
• Minimum five (5) years of experience in the healthcare industry; preferably with healthcare network operations and/or practice management
• Demonstrated understanding of risk and value-based contracting
• 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

Highly Preferred Skills, Abilities & Qualifications:

• 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

Equality Health provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.

This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation and training