This position is responsible for providing the oversight and direction for the clinical designing, implementing, and supporting of a system-wide population health management program, that is aligned with the "Triple Aim” and that works in a safety net health system setting. This job serves as the primary clinical business partner for Sinai Chicago’s population health team. The position plays an important internal role in shaping overall strategy and driving specific initiatives around population health, high-value network and value-based reimbursement. This role also serves an important external role in supporting market and network discussions and negotiations. Finally, this role acts as an agent of change within the Sinai Chicago physician community to promote the movement of the practice of medicine to value based care.
- The position is expected to drive value based outcomes through clinical incites from data analysis, payer relationships, IT solutions, clinical outcomes and collaboration with partner/FQHC leadership and operations.
- Communicates, collaborates and supports affiliate and system leaders regarding population health programs within hospital, ancillary and medical group operations.
- Identifies opportunities through data analysis for improvement in Sinai Chicago that will drive the success under population health programs. Responsible for understanding helping assimilate and translating data into insights. Collaborates with system leadership, SMG, SUHI, SCI and IT/Analytics to operationalize this strategy and achieve desired results. Drives the operationalization of necessary population health analytics, reports and EMR needs necessary to execute the strategy.
- Plays a principal role in the clinical development of a Clinically Integrated Network (CIN). Acts as Sinai Chicago’s internal and external physician champion in the development and operations of the CIN.
- Provides clear direction to the Sinai Chicago’s Medical Home Network (ACO) care management team ensuring that each team members practices to the full extent of license
- Acts as Progress Health’s PHO Medical Director for utilization management work, value-based reimbursement, population health strategy and care transformation
- Acts as Sinai Chicago’s chief clinician for any CMS Advanced Payment Mechanism (APM) work/programs
- Participates in the formulation of Sinai Chicago’s strategic direction as it relates to high value network design, the evolution to value-based reimbursement, and development and deployment of supporting population health infrastructure. Specifically be able to go deep in the design of value-based reimbursement and supporting population health infrastructure, including field-based practice transformation supporting advanced analytics (including analytics that leverage integrated claims and clinical data), and supporting tools and infrastructure.
- Works directly with the Chief Population Health and Growth Officer and the CFO to ensure that the population health infrastructure is financially sustainable
- Work closely with Chief Population Health officer and other business & clinical leaders to target innovative business opportunities and initiatives that advance Sinai Chicago’s strategy of accelerating care transformation and enhancing business performance
- Serve as the clinical provider-facing Subject Matter Expert on all things value based care.
- Must be able to function in a highly matrixed environment where resources can be limited. Creativity in execution of duties is essential.
- Other duties as assigned
- Manage and lead medical management team in achieving appropriate inpatient and outpatient utilization goals.
- Endorse and facilitate value based care education for network physicians.
- Achieve medical cost pmpm target (manage to budget).
- Achieve financial performance goal (manage to budget)
- Achieve patient/provider satisfaction score at normative benchmark.
- Achieve clinical quality improvement goal (immunizations, mammograms, flu vaccines, etc.).
- Required – MD and/or DO;
- Preferred Degree in Business
- Required 3 years in the Health Insurance Industry with 1 year in a Clinical Practice 1 year in a management role
- Preferred Proficient knowledge in Health Economics and Advanced Analytics
- Experience in working in Safety Net facilities preferred
- Experience in working with Medicaid and Medicare Advantage members preferred
LICENSES AND CERTIFICATIONS
- Required (one of the following) Medical Doctor, Doctor of Osteopathic Medicine