Job Description

DataStaff, Inc is seeking a Population Health AMH Program Lead for a long-term contract opportunity with one of our direct clients located in Raleigh, NC

* This position is hybrid; 4 days per week will be on-site

The Quality, Population Health, and Program Evaluation (QPHE) unit advances North Carolina’s vision of building an innovative, whole-person, well-coordinated system of care that addresses both medical and non-medical drivers of health and promotes health equity.

Position Description

The primary focus of this position will be on the implementation and management of NC Medicaid’s Advanced Medical Home Program (AMH). Developed by the AMH program as the primary vehicle for delivering local care management as the state transitioned to NC Medicaid Managed Care. Through AMHs, North Carolina seeks to build on the Carolina ACCESS primary care infrastructure for Medicaid and NC Health Choice enrollees and further strengthen the role of primary care in care management, positive health outcomes and improved member experience. Health plans are required to delegate care management functions to certain AMHs and to establish value-based payment arrangements with AMHs for a defined set of quality measures. The AMH program is designed to support increased provider responsibility for overall population health, member experience, and total cost of care.

The Population Health AMH Program Lead is responsible for leading care management and care delivery services for designated populations within the Quality, Population Health, and Evaluations (QPHE) Unit.

Description of Work

• Develop a deep understanding of the goals and requirements of the AMH program, Care Management for At-Risk Children (CMARC), and Care Management for High-Risk Pregnancies (CMHRP).
• Oversee policies and processes related to these programs, including strategic and technical elements.
• Participate in design and implementation of updates to the programs’ requirements and business processes.
• Work closely with AMH Program Specialist(s) to ensure program manuals, bulletins, website content, and other related publications are maintained.
• Collaborate with internal and external stakeholders to ensure success of the AMH, CMARC, and CMHRP programs.
• Serve as subject matter expert for any program evaluation design and implementation; make program recommendations based on data and evaluation results.
• Lead management of AMH Help Center tickets including researching issues, tracking progress, and providing responses or guidance.
• Monitor utilization and outcomes of the AMH and other Population Health care management programs. Support the development of dashboards and reports to monitor the programs.
• Utilize data and evaluation results to make program recommendations.
• Communicate results of work to multiple audiences and levels of management in a professional, meaningful, and understandable way.
• Lead selected special projects that require cross functional engagement with key internal and external stakeholders. Collaborate with AMH Program Specialist(s) to ensure projects are meeting expected benchmarks, timeframes, and outcomes.
• Serve on a variety of steering/oversight committees and workgroups.
• Build effective professional relationships with stakeholders to include providers, vendors, beneficiaries, advocates and associations.
• Effectively communicate the strategy and implementation steps for major process changes, policy deployments or new initiatives.
• Establish, interpret, and coordinate policies in accordance with regulations and contractual agreements.
• Build effective relationships with internal and external stakeholders, including but not limited to state agencies, PCCM entities, health plans, providers, beneficiaries, advocates and associations, to ensure open lines of communications.
• Maintain assigned work streams including active participation in meetings, facilitation of workgroups, development and delivery of presentations, timely follow-up to questions and concerns.
• Provide oversight of AMH Program Specialist(s) in the maintenance of assigned work streams and activities.
• Keep AMH Program Manager and Senior Program Manager abreast of policy and process changes, program and staff needs, and other relevant information.
• Support the QPHE leadership team in vendor relations and vendor oversight.

Competencies, Knowledge, Skills and Abilities Required

• Knowledge and experience in primary care, population health models, care delivery models, care management models, and clinical program innovations
• Broad knowledge of health care payer programs and policy, including Medicaid
• Ability to clearly communicate and present information to range of audiences in in-person and virtual formats
• Ability to effectively manage day-to-day activities of complex projects
• Ability to interpret data, data sets and other information and to identify and communicate trends and probable outcomes
• Ability to work independently and as part of a team
• Flexibility to adapt to shifting priorities and short-term deadlines
• Strong interpersonal, organization and detail orientation skills
• Excellent critical thinking, problem solving, and project management skills
• Proficient in MS Office including Word/Excel/PowerPoint

Minimum Education and Experience Required

• Master's degree in a discipline relative to the program from an appropriately accredited institution and four years of related experience; or
• Bachelor’s degree in a discipline relative to the program area from an appropriately accredited institution and six years of related experience; or an equivalent combination of education and experience.

This opportunity is available a W2 position with a competitive benefits package. DataStaff, Inc. offers medical, dental, and vision coverage options as well as paid vacation, sick, and holiday leave. As many of our opportunities are long-term, we also have a 401k program available for employees after 6 months.

Job Tags

Similar Jobs