Value Based Care Specialist

Responsibilities Review patient charts and payer portals to identify care gaps.

Contact patients directly to close care gaps and coordinate follow-up.

Ensure medical records are updated with the most current and accurate quality metric information Maintain and monitor attribution lists to track patient assignments/panels.

Collaborate with internal teams and external partners to align with best practices in population health.

Maintain detailed spreadsheets and documentation to track outreach and outcomes.

Support the development and implementation of processes that align with Value-Based Care goals.

Assist in benchmarking efforts by connecting with FQHCs (Federally Qualified Health Centers) to mirror successful Population Health models.

Program Coordination and Performance Management Serve as the primary liaison for payer value-based care (VBC) contracts, including Medicaid, Medicare, and commercial programs.

Under the supervision of the Associate Director of Care Coordination and Special Programs Assists in monitoring the performance on quality and cost metrics (e.g., preventive screenings, chronic disease management, ED utilization, and patient engagement).

Assists in developing and maintaining dashboards and assists with reports to track organizational performance against value-based care targets.

Assists in collaboration with care teams to identify gaps in care and support outreach and intervention strategies.

Participate in regular payer meetings and performance reviews, ensuring accurate reporting and timely submission of required data.

Quality and Population Health Support Assists in partnering with Quality and Care Management teams to align value-based metrics with UDS, HEDIS, and NCQA-PCMH quality goals.

Assists in supporting population health initiatives focused on preventive care, chronic disease management, and reducing health disparities.

Assist in analyzing data to identify trends and opportunities for performance improvement.

Assist in developing workflows and staff education to integrate value-based care principles into daily operations.

Assist in facilitating communication between clinical teams, payors, and leadership regarding quality and cost-of-care initiatives.

Data Management and Reporting Assists in working with the Data Analytics team to validate performance data and ensure accuracy of payer reports.

Utilize the Electronic Health Record (EHR) and data platforms to run quality measure reports and identify patients needing interventions.

Track incentive payments, performance bonuses, and financial outcomes associated with VBC contracts.

Assist in preparing documentation and evidence for audits, payer reviews, and compliance activities.

Collaboration and Education Assist in providing training and support to providers and staff on value-based care workflows, documentation, and coding best practices.

Promote understanding of how clinical quality performance impacts payer contracts and financial sustainability.

Assists in sup...