Practice Transformation Specialist; Remote, North Carolina

The Practice Transformation Specialist (PTS) works with Advanced Medical Homes (AMH+) and Care Management Agencies (CMA) in the Alliance Health region to improve quality of care. This position serves as a consultant to provider practice staff to improve patient outcomes by enhancing skills in process improvement, team-based care, encouraging patient engagement, sharing identified practice population trends, and analyzing quality data and performance measurements.

The Practice Transformation Specialist also collaborates with the Alliance Health Clinical Operations team in the development, implementation, and optimization of training materials used to facilitate practice transformation in the Alliance Provider Network. The Practice Transformation Specialist works with Clinically Integrated Networks to advance provider-p-led care management toward alternative payment models.

This position will allow the successful candidate to work a schedule that will be primarily remote. While there is no expectation of being in the office routinely, they will be required to come into the Alliance Office for business and team meetings as needed.

Provide Support to Network Providers

• Assist providers to evolve administrative and clinical workflows and processes aimed at improving outcome-based care. This starts with assisting care management providers with setting up their sites for billing, through claims processing and the shift to data informed care management
  -to include creating interventions, workflows and guidance with policy and procedures. This also includes understanding the data sent to the care management agencies and how to readily make the data usable for care managers
• Educate practice’s and CINs in CQI principles and practice. This includes education and coaching on different interventions, Plan, Do, Study, Act cycles, data used to drive care thus leading practices to improved member outcomes. This work will be coordinated with the clinically integrated networks (CINs)
• Meet with providers and CINs to review performance reports (including panel and engagement rates quality dashboards (including Gaps in Care, Medical Economic Dashboards (ED visits and utilization), and other data points that will drive CINs and Providers to improve member care. Practice Transformation Specialist must present data in an understandable format
• Collaborate with AMHs and CMA to support integrating administrative, financial, and clinical systems and data for better performance and improved outcomes; this includes conducting reporting on Gaps Analysis, using the Gaps Analysis and CQI Rubric to strengthen the performance of the care management entities, to present to the applicable CINs
• Facilitate agencies adoption of 1915(i) processes and impacts of HR. 1 and other state programs for their members

Provide Training & Coaching to Network Providers

• Deliver practice-level education, training and provide providers with toolkits for improving member care; including HEDIS Measures;
  Alliance operational initiatives and state requirements; such as 1915 I and HR.1
• Educate on available resources and systems, such as JIVA and NCCARES 360, Inovalon, Siftwell’s Pegasus, Alliance’s Medical Economics dashboards, and Micro Strategy reports. This includes knowledge of the technical files sent to the CINs and Care Management agencies and how to use the data from files to improve member outcomes
• Provide customized coaching at clinical sites (e.g. community health centers, PCP offices and comprehensive behavioral health provider sites) by working with the sites to identify site‑specific needs and opportunities, prioritizing areas of focus and identifying available and needed resources. Coaching includes use of data…