At Memorial Hermann, we pursue a common goal of delivering high quality, efficient care while creating exceptional experiences for every member of our community. When we say every member of our community, that includes our employees. We know that when our employees feel cared for, heard and valued, they are inspired to create moments that exceed expectations, while prioritizing safety, compassion, personalization and efficiency. If you want to advance your career and contribute to our vision of creating healthier communities, now and for generations to come, we want you to be a part of our team.

Job Summary

The Director of ACO Population Health is responsible and accountable for the enterprise implementation of Accountable Care Organization (ACO) Quality and Ambulatory Continuous Documentation Improvement (CDI) program. The functions of the ACO Quality Team consist of ACO Quality Coordinators, synchronous and asynchronous patient engagement, and MHMD/MHMG/High Performing Physician Network support for ACO Care Gap closure. The functions of the Ambulatory CDI program consist of coding auditors, Nurse Reviewers, and annual Risk Adjustment Profiles data submissions for health plan compliance.

The Director is responsible for organizing all aspects of data collection, report compilation and dissemination, and coordinated outreach efforts for ACO Quality efforts. This includes ACO Quality Coordinator outreach, development of ACO Quality workflows, and leveraging all available technology enabled communication channels for patients. This role supports ACO Quality across MHMD, MHMG, and the High Performing Network. Additionally, the Director will design, build, implement and maintain the Ambulatory CDI Program at Memorial Hermann with a focus on accurate documentation and coding to capture the disease burden of defined populations. Typically reports to the Associate Vice President for Population Health.

Job Description

MINIMUM QUALIFICATIONS

Education:  Bachelor’s degree in Health Administration, Health Sciences, Public Health, Nursing (BSN) or equivalent degree required. Masters preferred.

Licenses/Certifications: 

Certified Professional in Healthcare Quality (CPHQ) or Healthcare Quality and Management (CHCQM) preferred

Experience / Knowledge / Skills:

• Minimum five (5) years experience in programmatic population health quality care gap closure required

• Three (3) years of experience in ambulatory continuous documentation improvement for risk adjustment in Medicare populations required

• Five (5) years supervisory experience preferred

• Prior experience in Epic electronic medical record strongly preferred

• Self-motivated, proven communication skills, and takes initiative.

• Background in healthcare business planning and targeted outcomes

• Working knowledge of managed care, value-based care, population health, inpatient, outpatient, risk adjustment, and annual wellness visits

• Working knowledge of the concepts associated with Performance Improvement

• Demonstrated effective working relationship with physicians

• Ability to work collaboratively with health care professionals at all levels to achieve established goals and improve quality outcomes

• Effective oral and written communication skills

PRINCIPAL ACCOUNTABILITIES

• Plans, directs and supervises all aspects of the Memorial Hermann ACO Quality and Ambulatory CDI Risk Adjustment program.

• Facilitates growth and development of the ACO Quality and Ambulatory CDI Risk Adjustment programs consistent with enterprise-wide philosophy and in response to the dynamic nature of the health care environment through benchmarking for best practices, networking, quality management, and other activities as needed.

• Reporting to the AVP for Population Health, designs and implements the ACO Quality operating model through the ACO Quality and Risk Adjustment Factor Operations Committee

• Develops the Memorial Hermann Ambulatory CDI Program including the pre-visit planning process, the annual wellness visit encounter, and the post-visit CDI process. Develops parallel processes to support employed and independent physicians.

• Works to develop ACO RAF outcomes reporting in partnership with AVP for Population Health and the MHMD Analytics support team.

• Ensures that ACO Quality and Ambulatory CDI program efforts are aligned to support MHMD, MHMG, and the High Performing Physician Network.

• Works to increase the accuracy of coding and documentation to reflect the disease burden of Medicare beneficiaries across the enterprise. Partners with health plans to improve RAF data submissions through encounter files.  

• Responsible for approving and managing the day to day ACO Quality and Ambulatory CDI operational budget.

• Responsible for leading a high performance team of “system thinkers” who incorporate leadership principles and vision in performing the functions of care coordination.

• Uses data to drive decisions, plan, and implement performance improvement strategies for care coordination.

• Participates in this evolutionary process by constantly identifying future needs of current customers and/or identifying potential new customers.

• Responsible for departmental personnel functions in conjunction with the AVP, Population Health

• Writes and conducts annual and interim performance appraisal reviews for the professional and non-professional staff in department.

• Acts as liaison to facilitate communication and collaboration between all care partners (physicians, hospitalists, community care managers, nurses, community resources, etc.).

• Ensures safe care to patients, staff and visitors; adheres to all Memorial Hermann policies, procedures, and standards within budgetary specifications including time management, supply management, productivity and quality of service.

• Promotes individual professional growth and development by meeting requirements for mandatory/continuing education and skills competency; supports department-based goals which contribute to the success of the organization; serves as preceptor, mentor and resource to less experienced staff.

• Demonstrates commitment to caring for every member of our community by creating compassionate and personalized experiences. Models Memorial Hermann’s service standards of providing safe, caring, personalized and efficient experiences to patients and our workforce.

• Other duties as assigned.