Medical Director - Population Health Management
Kern Family Health Care, 2900 Buck Owens Blvd., Bakersfield, California, United States of America Req #1524
We appreciate your interest in our organization and assure you that we are sincerely interested in your qualifications. A clear understanding of your background and work history will help us potentially place you in a position that meets your objectives and those of the organization. Qualified applicants are considered for positions without regard to race, color, religion, sex (including pregnancy, childbirth and breastfeeding, or any related medical conditions), national origin, ancestry, age, marital or veteran status, sexual orientation, gender identity, genetic information, gender expression, military status, or the presence of a non-job related medical condition or disability (mental or physical).
Our Mission. Kern Health Systems is dedicated to improving the health status of our members through an integrated managed health care delivery system.
Under the general direction of the KHS Chief Medical Officer the Population Health Medical Director (PHM) will work directly with the KHS Leadership Team in the development and implementation of a cohesive approach to population health initiatives to promote access, equity, quality, and enhanced patient and provider experience for MassHealth members.
In collaboration with the Chief Medical Officer and others, the Medical Director creates and implements health plan Population Health clinical pathways and protocols. The PHM Medical Director represents the health plan on various committees and may report to the Board of Directors on Population Health activities and programs.
- Uses synthesized population health inputs and data, oversee the process of development and ongoing maintenance of strategic population health priorities for directing KHS population health strategic planning
- Regularly reports to KHS leadership (executive team) on the status of population health projects and progress towards population health priorities.
- In partnership with relevant KHS teams, oversees design and maintenance of KHS population health dashboard to include quality, member experience, cost, and utilization data for decision-making around promoting high quality, equitable, efficient, and person-centered care for MassHealth members.
- Identify and manage necessary analytics resources to support KHS population health functions, including by coordinating with KHS BI and analytics staff.
- Develop and maintain a good understanding of how to utilize data and analytics resources available to KHS, and efficiently access such resources as needed to support KHS population health management program
- Provide clinical leadership to KHS population health management department to plan, organize, and direct the completion of specific population health projects prioritized by KHS leadership, on time and in scope.
- Convene and provide direction to teams including KHS policy, clinical, quality, data, and analytics staff
- Provide leadership for the development, implementation and evaluation of population health initiatives designed to keep members healthy, manage emerging member health risk and assist members with managing chronic conditions.
- Manage current programs and creating new innovative and member/client-focused solutions.
- Engage with and lead working relationships with key delivery system partners and purchasers involved in value-based care networks, contracts, and products.
- Manage accountability for value based operational performance metrics including quality, financial, Triple AIM metrics, and translate these into actionable items based on provider or group specifics.
- Collaborate with internal stakeholders to create effective information and analyses to optimize population health, quality, and value-based care performance and strategic objectives.
- Develop and implement processes for data collection and exchange with delivery system partners and purchasers involved in value-based care arrangements.
- Facilitates identification, adoption, implementation, and utilization of “best practice” clinical practice guidelines and engagement protocols for management of specific diseases/conditions.
- Identify populations of members/patients who would benefit from participating in a chronic disease management/population health or quality improvement program and use social determinants of health data in building tools, processes, and partnerships, to positively impact these metrics and outcomes.
- Serves as a strategic partner to all other KHS departments to coordinate projects, ensuring team, department and company goals are consistently achieved in relation to Population Health, Quality, and Value-based Care.
- Design and develop programs that integrate complex care, long-term services and support, care and disease management, care transitions, care coordination, and other services that meet contractual and regulatory requirements.
- Responsible for focused measurement of program performance.
- Provide clinical leadership in developing and implementing quality data systems for population health management, engaging physicians and advanced care practitioners through data reporting, scorecards/dashboards, and metrics.
- Work collaboratively with leaders of the Utilization Management team to ensure consistency across various programs focused on managing overall care delivery for members.
- Participate in the oversight and leadership to ensure outcomes, quality standards, and accreditation standards are met.
- Collaborate cross-functionally to manage the coordination and delivery of quality care and outcomes, member and provider outreach, care management strategies across the member populations, and provider network.
- Coordinate with technical and operational leaders throughout KHS to ensure capabilities and processes are in place to effectively deliver population health management programs
Core Competencies/Knowledge & Skill Requirement
- Extensive experience directly leading large teams and working in a matrixed team environment with evidence demonstrating strong relationship building skills.
- Experience leading teams that have been responsible for overall performance in Population Health. Understanding of Quality and Value-based care and population health management
- Familiarity with state regulatory and NCQA accreditation standards and process; familiarity with business process redesign principles.
- Ability to be self-directed and work independently with little supervision.
- Ability to work well under pressure, multi-task and track complex projects, and solve complex problems. Strong communication skills – written and verbal, internal and external
- Demonstrates strong organizational skills and ability to organize and prioritize to meet established deadlines.
- Strong facilitation skills with the ability to run provider meetings with a prioritized topic agenda.
- Strong background working with and improving clinical quality metrics, as well as other health plan quality metrics.
- Demonstrated a deep understanding of care delivery and quality improvement and has a successful track record of improving quality of care and delivering triple aim goals.
- Presents a positive and professional image internally, with providers, and more broadly in the communities we serve.
- Ability to maintain strict confidentiality and adhere to all healthcare laws and regulations.
- Knowledge of managed care including Medicaid and Medicare requirements.
- Strong strategic, analytic, and critical thinking skills with proven ability to use EHR, administrative and claims data to identify opportunities, inform program design and measure process, clinical and financial outcomes.
- Excellent ability to work well in a team setting.
- Ability to interact effectively and in a supportive manner with persons of all backgrounds.
- Excellent communication and interpersonal skills.
- Commits to the mission, vision, beliefs and consistently demonstrates our core values.
- Responsible for maintaining strong, positive relationships with physicians, advanced care practitioners and other clinical staff.
- M.D. or D.O. from a recognized academic institution with board certification in a specialty field of practice highly desired.
- Current, valid, unrestricted California Physician & Surgeon’s License with Board certification in area of specialty required.
- Master’s level degree or higher in healthcare, business MBA), or public health (MPH/PP) desirable.
- Minimum of ten (10) years clinical practice experience and five (5) years in a leadership role in a health system, clinical practice or a payer with a particular emphasis on value based care, e.g., Population Health, ACO or MSO.
- Possession of valid California Driver’s License and proof of valid State required auto liability insurance. Required travel up to 10%
- Bilingual (English/Spanish) preferred
We are an equal opportunity employer, dedicated to a policy of non-discrimination in employment on any basis.