CCI Health and Wellness Services is a group practice, empowering patients to partner with staff for an unparalleled healthcare experience. Through integrated teams in a learning environment, we deliver high quality, affordable, care to every patient during all stages of life.
The Population Health/Risk Manager is responsible for the clinical data aspects of all quality improvement initiatives as well as the provision of leadership for all Population Health Management activities at CCI Health and Wellness Services.
As a member of the health center’s integrated care team, the Population Health/Risk Manager will fulfill the following KEY FUNCTIONS AND RESPONSIBILITIES towards the provision of patient centered, coordinated patient care:
- Provides clinical insight for quality improvement initiatives:
- Coordinates and serves as the clinical expert for all system wide projects including but not limited to: PCMH, HEDIS, UDS, Meaningful Use, TJC
- Monitors and evaluates performance data, noting patterns, trends, and efficiency levels
- Works with quality teams to plan, initiate, and maintain patient improvement measures
- Prepare and present quarterly reports detailing findings and improvements generated from PDSA and process improvement initiatives
- Monitor changes in FQHC quality initiatives and guidelines
- Create and monitor PDSAs and other quality initiatives
- Adherence to HEDIS measures
- Provides Population Health Management Program Leadership
- Serves as a CCI representative to Managed Care Organizations (MCO) or other strategic partners as designated by the CEO
- Assists with audits and reviews from outside sources
- Provides training to staff as necessary (including utilization review and medical coding)
- Facilitates implementation of the Quality Improvement Plan
- Promotes and fosters an atmosphere of teamwork and excellence among staff.
- Applies principles of growth and development of all age groups according to facility policies and procedures in the performance of his or her job duties.
- Develops annual goals concerning risk management. Employs a vision to develop new concepts and solutions.
- Is inspired to succeed and driven to deliver on goals and expectations
- Leads by example to provide Center-wide high-quality care that is patient centered and meets CCI’s established standards.
- Develops and maintains an incident reporting system by establishing a comprehensive incident reporting plan that establishes policies, educational programs, and reporting methods for the appropriate areas.
- Evaluates all incidents for severity, frequency, and probability of financial loss, and reports as necessary to appropriate administration, committees and personnel.
- Directs information on incidents as appropriate to medical staff and other peer review processes.
- Uses industry benchmarking to compare appropriate data.
- Directs the risk investigation of all identified potentially compensable events (patient, visitor, employee, and product).
- Develops loss control measures relating to patient care complaints, including, but not limited to, access to medical care and the provision of certain treatments when appropriate.
- Develops and implements preventive risk management programs. Educates and trains staff in appropriate procedures, documentation, reporting and follow-up in key areas of risk management interest. Acts as the facility's expert resource in risk reduction and keeps abreast of trends in the industry.
- Reviews and revises the risk management plan and all risk management policies on an annual basis.
- Prepares and manages budgetary items related to risk management.
- Prepares documentation and promotes compliance with internal policies and external regulations regarding areas of risk management responsibility, including but not limited to root cause analyses.
- Develops statistical and qualitative reports on risk management trends and patterns and communicates this information effectively to appropriate audiences.
- Serves as a resource to facility staff on issues related to risk management and patient safety.
- Demonstrates role model behavior regarding proper customer satisfaction, conduct, confidentiality, complaint resolution, and problem solving.
- Ensures that personnel take appropriate steps so that risks are minimized through follow-up and actions on all regulatory/insurance survey report recommendations/deficiencies.
- Proactively recommends appropriate revisions to new or existing policies and procedures to eliminate or reduce risk and to prevent future occurrences.