Senior Population Health Consultant

Position Description

Base pay is influenced by several factors including a candidate’s qualifications, relevant experience, and anticipated contributions to meet the needs of the business, along with internal pay equity and external market driven rates. The salary range displayed has not been adjusted for geographical location. This range has been created in good faith based on information known to Capital Blue Cross at the time of posting and may be modified in the future. Capital Blue Cross offers a comprehensive benefits packaging including Medical, Dental & Vision coverage, a Retirement Plan, generous time off including Paid Time Off, Holidays, and Volunteer time off, an Incentive Plan, Tuition Reimbursement, and more. 

At Capital Blue Cross, we promise to go the extra mile for our team and our community. This promise is at the heart of our culture, and it’s why our employees consistently vote us one of the “Best Places to Work in PA.”

The Senior Population Health Consultant is responsible for the design, development and implementation of clinical and service quality improvement initiatives focusing on improved member health, experience of care, and medical costs. This would include targeted efforts to not only improve Capital's accreditation status and associated HEDIS, STAR, and an understanding of patient satisfaction surveys and results, but to also work collaboratively and cross-functionally across the company to raise awareness of current status and drive improvement projects being implemented and/or that are already in place to optimize plan performance. Responsibilities include evaluating and identifying improvement opportunities, proposing and/or designing interventions, overseeing implementation, and evaluating the efficacy of the interventions. The Population Health Consultant participates in corporate and departmental projects that support medical value initiatives and the corporate goals/mission. The Senior Population Health Consultant also works directly with Capital network providers and collaborate with many internal stakeholders to champion provider practice transformation in support of Capital BlueCross' value based delivery models, leading the day to day execution of value based provider projects and initiatives and is the primary external quality representative for Capital network providers. This position further supports accreditation and regulatory compliance by evaluating program effectiveness, identifying and acting on improvement opportunities, and ensuring that documentation and policies/procedures meet accreditation and regulatory requirements.

Responsibilities and Qualifications

• Collaborate across the company, with vendors, and key external stakeholders in order to drive improvements in plan performance (HEDIS and STARS results) through medical value initiatives.
• Work with leaders to identify, plan, organize, and manage strategic projects and frameworks for improvement to build a project portfolio that supports improvements in population health, experience of care and cost reduction.
• Develop and oversee medical value programs and initiatives to improve plan market measure results. Seeks innovative and creative ways to disseminate information and improve results.
• Attend industry conferences and events, both local and national, to maintain a contemporary awareness of industry, CMS regulations, Medicare Quality Improvement (HEDIS/STAR) solutions, benefits and programs that will enhance strategy development, recommendations and decision making.
• Communicate medical value activities with internal stakeholders and external customers.
• Assist in meeting regulatory requirements by developing, managing and documenting federal and state mandated improvement projects.
• Participate in accreditation activities that support the departmental and organizational goals by ensuring that activities contribute to Capital’s Quality Improvement Program compliance with accreditation bodies such as URAC and NCQA as well as state and federal regulatory requirements.
• Promote a positive public image and effectively and efficiently develops and facilitates relationships with both internal and external stakeholders that will leverage the success of the organization to improve medical value.
• Compile data and reports from a variety of reporting sources and databases to analyze HEDIS/Star Measures for opportunities for improvement and integration in medical value programs and initiatives.
• Provide quality improvement support to the Value Based Initiative, Network Management Contracting and Provider Service Organization unit by acting in a consultative manner and participating in various work groups and committees.
• Assist in the development of quality metric specifications, data collection tools, scoring methodology, and establishment of performance goal/benchmarki