Director, Population Health

We offer remote work opportunities (AK, AR, AZ, CO, FL, HI, IA, , IL, KS, LA, MD, MN, MO, MT, NE, NV, NM, NC, ND, OK, OR, SC, SD, TN, TX, UT, VA/DC, WA, WI & WY only).

Our Department of Defense contract requires US citizenship and a favorably adjudicated DOD background investigation for this position.

Veterans, Reservists, Guardsmen, and military family members are encouraged to apply!

This role will be responsible for leading and implementing a complete Population Health program in support of the T-5 TRICARE West Region contract. This leader will collaborate with data management to utilize predictive and prescriptive analytics to stratify our beneficiary population for inclusion in multiple Medical Management programs; direct staff and interventions that will improve beneficiary health outcomes including HEDIS scores;

develop and implement clinical programs to optimize Condition/Disease Management strategies and goals; and collaborate with leadership to enhance the overall healthcare education and knowledge of our beneficiaries using multiple platforms and experiences.

• Bachelor's degree in Nursing, Health Care Administration, or Information Management
• Minimum of five years of management, with increasingly responsible experience in health care organization or managed care organization
• Minimum of five years of clinical experience
• Minimum of five years of disease management or population health operation and program development
• Experience in product development, project management, data management, data analysis, and team management

• Master's Degree in Nursing, Health Care Administration or Business Administration
• Direct experience in population health programs
• Experience with HEDIS, data analysis and wellness program development
• Knowledge of government health care programs, TRICARE, and Medicare/Medicaid

• Direct the overall operational leadership of Population Health (PH) functions and staff to ensure compliance with contract requirements and adherence to contract deliverables
• Develop and implement Condition/Disease Management (DM) programs that meet contract, HIPAA privacy and URAC requirements
• Develops and implements strategies to meet department objective to improve preventive care rates and demonstrate advances in population health markers
• Research high priority issues; including but not limited to predictive modeling, wellness and prevention programs, HEDIS, and programs to improve effectiveness of health care management programs
• Oversee development of desk procedures, education and auditing to support uniform application of programs and compliance with program policy and standards
• Directs the design of data collection tools, reports and administrative protocols for all PH programs performance management and contract reporting
• Work with executive leadership to ensure targets are met for the annual operating plan/financial management
• Performs annual and ongoing evaluation of the DM and PH programs to ensure adherence to URAC standards, TRICARE policy, contractual requirements, and nationally recognized practice standards
• Coordinate with Medical Director to educate and communicate expectations with providers
• Collaborates with network providers, Military Treatment Facilities and TRICARE Regional Office West (TROW) regarding Population Health program initiatives and responds to requests for assistance for program information or data
• Serves as designated Point of Contact to the TRICARE Regional Office West (TROW) on matters related to Population Health processes and contractual requirements
• Performs other duties as assigned
• Regular and reliable attendance is required

Ability to influence…