Manager, Provider Practice Transformation

FLSA Status: Exempt

Department: Provider Network Operations

Reports To: Director, Provider Network Operations

 

GENERAL DESCRIPTION OF POSITION

The Manager, Provider Practice Transformation is responsible for providing day-to-day management and leadership of the Provider Network Operations team responsible for quality improvement within SCFHP’s provider network including SCFHP’s Provider Performance Program (PPP), and practice transformation activities. This includes but is not limited to, identifying opportunities for improvement from the perspective of clinical operations, service quality, financial performance, and health equity. The manager is accountable for development and execution of all strategies to improve network performance including communication, outreach, implementation, training, education, service, measurement and reporting of quality improvement and practice transformation initiatives. This position develops and maintains trusting relationships with providers, staff and leadership of contracted health plans, physicians, hospitals, ancillary providers, and IPAs to successfully drive innovation and continuous quality improvement. The Manager works collaboratively with SCFHP’s Quality Improvement, Health Equity, and Risk Adjustment teams to further PPP and practice transformation initiatives, and with the Director, Provider Network Operations, representing the department at management and cross-functional meetings and interfacing with other departments as necessary.

ESSENTIAL DUTIES AND RESPONSIBILITIES
To perform this job successfully, an individual must be able to perform each essential duty listed below satisfactorily.

1. Develop and maintain in depth market knowledge regarding the provider community in Santa Clara County.
2. Develop and maintain an understanding of physician practice operations, quality improvement, HEDIS, and pay-for-performance programs.
3. Develop comprehensive training and resource materials related to SCFHP practice transformation activities, processes and procedures, HEDIS and the PPP program. This includes drafting and maintaining practice transformation related content for the SCFHP Provider Manual, website and provider portal, provider newsletters, bulletins, tool kits, the PPP Guide, and other planned and ad hoc provider communications.
4. Develop and conduct internal training across departments to assure appropriate knowledge and tools exist throughout the organization for servicing providers and understanding handoffs between departments.
5. Work closely with the Manager of Quality Improvement, SCFHP’s Health Equity, DSNP Stars, and Risk Adjustment teams, and internal/external cross-functional groups to develop interventions and ensure timely execution of deliverables for practice transformation projects.
6. Effectively manage SCFHP’s practice transformation consultants to ensure deliverables are met.
7. Represent the department at SCFHP committee meetings. Act as a subject matter expert for cross-functional activities. Be the voice of the provider community at SCFHP, communicating the needs of the provider network as they relate to the practice transformation processes, policies and performance.
8. Hire, manage and develop the PPP team to develop effective communication strategies, including timely, documented efforts related to education of new and existing providers, questions from providers, interventions addressing concerns regarding quality of service impacting health plan members, and action plans that pertain to specific initiatives with the SCFHP provider network.
9. Represent SCFHP in the provider community for quality of care, HEDIS, and PPP, including but not limited to, representing the department and SCFHP at internal and external meetings and events.
10. Manage the planning, execution and evaluation of QIHEP initiatives, HEDIS and practice transformation provider projects from initiation/pilot phase through project closure to improve quality performance, SCFHP’s HEDIS scores, and other quality metrics. Establish metrics to monitor ongoing results.
    Communicate clearly and concisely with providers at all levels, including administration, the provider office staff and relevant vendors; convey information to internal departments and organizational leadership when appropriate.
11. Conduct studies on operations, workflows, and fact gathering sessions with providers and transformation consultants to document, quantify, and specify quality improvement efforts. Work with providers and internal/external stakeholders to identify gaps and solutions to closing gaps between current and desired results.
12. Manage compliance with applicable regulatory and reporting requirements; monitor new requirements and update required program docu