TITLE: Director of Clinical Practice Transformation
DIVISION: CMA Physician Services Organization (CMA-PSO)
REPORTS TO: Chief Strategy Officer, CMA-PSO
OFFICE LOCATION: Sacramento
EXEMPTION STATUS: Exempt
POSITION SUMMARY: The CMA-PSO is looking for a Director of Clinical Practice Transformation. The Director will help the CMA-PSO facilitate transformative change within primary and/or specialty care practices. The Director will assist the CMA-PSO with developing its practice transformation process and tools, aimed at building practices’ overall capacity for ongoing and sustainable change to high-performing medical practices. The Director will also assist the CMA-PSO in developing out and leading a successful team of specialists to provide generalized and specialized in-practice support.
The Director must have effective, long-term relationships with physicians and practice groups across California to introduce and drive a culture of practice optimization and learning. The Director will have had experience working with health information technology (EHR’s, clinical registries, etc.), practice management services, qualitive and utilization improvement metrics, revenue cycle management, practice engagement and marketing optimization, and coding and billing optimization. The Director will be able to skillfully utilize these and other such medical management services and tools to assist physicians and practice groups in optimizing their capabilities to succeed in data-driven population health management, improved access and continuity of care, patient engagement, coordination of care, and care management. The Director will also be able to utilize these tools/services to ensure that goals and measures for monitoring and evaluating success of various value-based and other such programs are executed at the practice level, while being inclusive of other providers and payors to ultimately achieve the triple aim – better care, smarter spending, and healthier people.
- Helps identify, contract with, and deploy key medical management tools and services to optimize physician practices.
- Develops a team of practice transformation specialists to facilitate the progression of primary and specialty care practices across California from their current state of care delivery to a highly-functioning, transformed medical practice.
- Contributes to goal- and measure-setting, to monitor and evaluate success within various payment models, with a particular focus on value-based care.
- Along with team, lead the progression of partner practices.
- Effectively utilizes inquiry-based approaches to create organizational and practice improvement and to elicit meaningful information foundational to initiate and drive change within the practices.
- Leads team in working with practices in mapping and redesigning of workflows and processes toward the goal of improving cost, quality, and patient satisfaction outcomes.
- Assesses and collects data and outcomes that support practices redesign efforts in the performance of process reviews.
- Provides training, technical assistance and consultative guidance to the practice.
- Drives cross pollination of best practices/best approaches and collaboration among assigned practices.
- Interprets and presents analytic reports on cost, quality, utilization, patient experience, and risk adjustment to support practices in their development and implementation of strategies and tactics to transform practices’ outcomes and results.
- Accountable for introduction and education on the value and use of reporting tools, registries and delivery of reports.
- Build and effectively maintain relationship with the practice leadership actively involved in transformation efforts.
- Works collaboratively with the CMA-PSO internal practice engagement team and affiliated partners to provide comprehensive and coordinated support to practices as they transform.
- Assists and supports CMA-PSO leaders in summarizing and disseminating experiences and related learnings by way of team updates, written reports or presentations.
- Identifies challenges and barriers that may prevent practices/systems from meeting desired outcomes and facilitates results-driven, solution-focused discussion, ultimately bridging CMA-PSO’s business objectives with the practices, bringing to bear solutions of mutual benefit.
- Bachelor’s degree in nursing, business administration, health care administration, organizational leadership or other relevant academic discipline with 10+ years of experience in healthcare, preferably primary care, or any combination of education and experience providing the types and levels of knowledge, skills, and abilities required of the role.
- Proficient understanding of medical management services and tools that are fundamental to the success and operations of a practice group, including knowledge and techniques of how to effectively facilitate physician-led, team based, coordinated and holistic care.
- Thorough understanding of value-based care, alternative payment models and the role of primary and specialty, pharmacy, and hospital care in directing care and delivering value within the healthcare ecosystem.
- Possesses a command of quality and outcomes framework (such as HEDIS measures), the Consumer Assessment of Health Plan Survey (CAHPS), RAF scoring, and risk adjustment (accurately capturing the illness burden of the patient/member population through medical coding).
- Demonstrated proficiency in driving organizational and systemic change focusing on practice optimization and quality improvement opportunities surrounding people, process, and technology.
- Experience in interpreting analytic reports on cost, quality and utilization and developing and implementing strategies and tactics for improvement.
- Ability to demonstrate strong communication and problem-solving skills with the capacity to anticipate and identify needs from practices/systems.
- Ability to demonstrate flexibility and adaptability in a rapidly changing environment.
- Highly organized and detail oriented.
- Friendly and passionate about helping California’s physician groups become or maintain independence.
- Master’s degree or higher with previous experience performing practice transformation.
- Demonstrated proficiency in the use of health information technology (EHR’s, Clinical Registries, etc.) in clinical practice improvement and population health management.
- Experience in integrating medical management tools and services into primary care settings.
- Experience implementing practice-based chronic care management services.
(This job description reflects the general level and nature of the job. It is not intended to be all inclusive.)