Job Description

The Vice President, Population Health Strategy will provide strategic and operational oversight for a portfolio of population health management, quality programs, pharmacy operations, and ancillary patient care services in order to improve Hill Physicians Medical Group’s clinical and financial performance. Collaborate with VP Clinical Services and medical directors to identify and implement strategic priorities.

Location: This position will be a hybrid role, with the expectation to work onsite or in-person at least two days a week. The candidate must live in or be willing to relocate to San Ramon, CA, Stockton, CA or Sacramento, CA.

Compensation Range: The base salary range for this position is $260,700 - $388,100 – 415,500 for individuals with a proven track record and experience as a physician leader in an organization of similar scope. The target base range is $350,000. In addition, this executive will be eligible for an annual incentive performance bonus, and a long-term incentive performance bonus. The salary of the finalist selected for this role will be determined based on various factors, including but not limited to scope of role, level of experience, education, accomplishments, internal equity, budget, and subject to Fair Market Value evaluation. The base compensation range listed is a good faith determination of potential base compensation at the time of this job advertisement and may be modified in the future.

KEY RELATIONSHIPS

Reports to

• Chief Medical Officer, HPMG and PriMed

Direct reports

• Senior Director, Pharmacy Services
• Director, Clinical Quality
• Manager, Community Health

Other key relationships

• CEO, PriMed and Hill Physicians
• PriMed Executive Team
• VP Clinical Services
• Medical Directors
• Care Management / Concurrent Review
• Utilization Management
• Compliance
• IT
• Relevant HPMG Board Committees
• Health Plans
• Physician and Provider Network

KEY RESPONSIBILITIES

Pharmacy Operations and Ancillary Services

• Hold comprehensive planning, development, and management responsibility for pharmacy and ancillary patient care services; ensure that these services are integrated across PriMed departments and the Hill Physicians network.
• Ensure effective liaison with internal and external stakeholders regarding quality, clinical, and operational issues and initiatives.
• Develop and implement clinical programs and operational changes to improve care and manage financial risk involving pharmacy and ancillary services.
• Provides executive business line leadership, direction, decision-making and oversight for all Clinical Pharmacy Services, including drug use management, clinical drug guidelines, and clinical initiatives, as well as provider reimbursement for medical benefit drugs.
• e development and consistent deployment of processes and tools to measure and achieve quality targets, metrics, outcomes, and goals within all Clinical Pharmacy Service programs (i.e., Virtual Pharmacy Program).
• Provide short-term solutions and long-term strategy to manage a $50 million plus medical benefit drug budget and responsible for achieving the Health Plans/ACO pharmacy benefit percent generic and PMPM targets.
• Provide drug management strategies (i.e., site of service redirection, innovative drug reimbursement methodologies, biosimilars, etc.) for global risk product, PPO ACOs/CINs, and other shared risk arrangements.
• Establish and manage Pharmacist Collaborative Practice Agreement and associated protocols and workflows.

Quality and Performance Improvement

• Lead, support and integrate performance improvement initiatives of Hill Physicians’ internal stakeholders: physician leaders, PriMed clinical business owners, network services, and clinical analysis and IT staff.
• In collaboration with internal stakeholders, provide management oversight for development of quality and population health metrics, dashboards, and benchmarks based on state and national health care standards, practice guidelines, and/or published best practices.
• Provide quality improvement expertise and consultation to internal stakeholders in understanding and responding to Hill Physicians performance as measured by external bodies, e.g., health plans and the Integrated Healthcare Association, as well as variations in internal clinical and financial metrics.
• Provide management oversight for the development of clinical practice guidelines by relevant internal stakeholders in order to promote innovative patient management, evidence-based practice, and the most appropriate and cost-effective medical services.
• Responsible for development and execution of PriMed and Hill Physicians quality strategy for performance improvement across all LOBs and incentive programs.
• Responsible for the end to end process, submission, audit, and performance improvement of the IHA Value-Based P4P program.
• Responsible for implementing clinical programs and leading performance improvement in the MAPD CMS Stars Part C & D, HEDIS Medi-Cal, PPO, ACO and Direct to Employer quality incentive programs.

Community Health

• Provide executive business line leadership over the creation, direction, and review of programs that advocate for healthy behaviors to prevent disease, disease progression or advanced disease.
• Develop, implement, and lead the strategy to reduce long-term total cost of care by providing health coaching, and prevention services for the pre-disease populations.
• Oversee innovative and comprehensive clinical programs to serve targeted healthy, pre-disease, and chronic disease populations with timely analytics and measurable outcomes.
• Responsible for hiring, training, and leading multi-disciplinary team to carry out effective outreach for individuals, groups, or whole populations while leveraging technology for increased efficiency.
• Design and deploy innovative programs that provide coordination of care and patient services at the population level on behalf of the network physicians to close gaps in care.
• Develop 3-year roadmap and execute on SDoH strategies to improve health outcomes and reduce inappropriate utilization.
• Implement and scale the Community Health Advocate (CHA) program and build team to focus on assisting patients with social needs.
• Responsible for scaling CHA program and demonstrate positive ROI.
• Develop, implement and/or enhance clinical programs, data acquisition for race/ethnicity/language data to address health disparity and equity.

Data Analytics & Technology

• Business owner of HillMetrics (Cozeva), EPIC Healthy Planet, and other technology platforms that enable patients, providers, care teams and staff to deliver more efficient and higher quality care.
• Oversee and lead the implementation, business requirements and adoption of quality and population health technology platforms.
• Owner of clinical data for the organization; Responsible for representing all other stakeholders of clinical data and collaborating with IT to ensure high quality data is properly governed, maintained and consumed within all the appropriate downstream systems.
• Responsible for developing and leading the short-term and long-term strategy to optimize clinical data for population health management, performance improvement activities, business intelligence analytics, quality incentive programs and care management activities.

Population Health Management

• Implement a population health management and performance improvement program to ensure that HPMG is providing high quality care in integrated and non-integrated settings based on the most current knowledge of industry standards and best practices.
• Ensure compliance with all applicable laws, regulations and accreditation standards while providing high quality customer care and service.
• Ensure strategic initiatives are implemented to best position Hill Physicians and PriMed in the marketplace.
• Develop and oversee a robust quality performance improvement, and disease prevention/management programs and ongoing use of data in decision making at all levels.
• Ensure population health programs are regularly evaluated, demonstrate desirable clinical outcomes and positive ROIs.
• Business owner of CipherHealth technology; leverage omni-channel patient communication for key population health outreach campaigns.

IDEAL EXPERIENCE

• 5+ years of progressive clinical operations leadership experience in a health plan or medical group of significant size
• California experience preferred
• Experience overseeing quality improvement, utilization management, care management, population health
• Knowledge of Medicare, Medicaid, and commercial lines of business
• Innovative, tech savvy leader with working knowledge of Epic, clinical data exchange products and population health platforms (e.g., Compass Rose, Healthy Planet)
• Experience with Lean and/or similar performance improvement methodologies.
• MD or DO required; California medical license in good standing.

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