Job Description

Steward Health Care System LLC ("Steward") is a fully integrated, physician-led national health care services organization committed to providing the highest quality of care in the most cost-efficient manner in the communities where our patients live. Steward - the largest privately held health care company in the U.S. - owns and operations 35 community hospitals across nine states, serves over 1,000 distinct communities and employs approximately 40,000 health care professionals. In addition to our hospitals, the Steward provider network includes 4,800 providers, 25 urgent care centers, 87 preferred skilled nursing facilities, substantial behavioral health offerings, over 7,300 hospital beds under management, and approximately 1.5 million full risk covered lives through the company's managed care and health insurance services. The total number of paneled lives within Steward's integrated care network is projected to reach 3 million in 2018.

Steward Medical Group (SMG), Inc. is Steward's multi-specialty group practice with over 4,500 employees including over 1,800 physicians and advanced practitioners. SMG operates approximately 450 practice locations throughout Massachusetts, Southern New Hampshire, Rhode Island, New Jersey, Pennsylvania, Ohio, Florida, Utah, Arizona, Texas, Louisiana and Arkansas, and provides more than 4 million patient encounters per year.

Position Purpose:

The Quality Navigator position is a Steward Medical Group (SMG) practice based position, responsible for monitoring Blue Cross Blue Shield (BCBS) quality as well as future quality contracts that are added to the Louisiana market. The Quality Navigator will work closely with practice clinical staff and champion driving quality metrics performance.

Key Responsibilities:

  • Onboard new SMG PCP providers into Louisiana quality programs and performance initiatives.
  • Champion quality performance for any new contracts we add with other payors.
  • This position would also periodically review and implement clinical processes and EMR templates in order to improve quality data scoring and capturing.
  • FTE would work directly w/ our quality payors w/ periodic meetings/calls to improve communication and performance of our SMG providers.
  • Develops strong working relationships with SMG clinical practice staff to close gaps in care for patients to improve quality scores.
  • Uses data and clinical expertise to drive program performance communicating with key internal and external stakeholder’s to assist in continually improving clinical care and performance using best practices. Maintain/improve quality scores of current SMG providers, w/ initial focus on BCBS LA quality contract.
  • Meets regularly with internal / external staff to review data and develop strategies that drive continuous improvement.
  • Works with management and is responsible for monthly performance targets based on real time metrics as well as claims based data.
  • Assists key stakeholders in implementing care via partnered and preferred agencies.
  • Demonstrates leadership that creates and fosters a culture of continuous improvement.
  • Performs all job functions in compliance with applicable federal, state, local, and company policies and procedures.
  • Other duties as assigned.

Education:

  • Certified LPN or RN
  • Broad clinical background desired

Years of Experience:

  • Minimum three-five years’ experience in care management role (preferably in a physician practice setting)

Specialized Knowledge:

  • Self-starter able to work as an individual contributor and as part of a team
  • Demonstrated ability to interact with and influence internal and external key stakeholders
  • Excellent critical-thinking, observation, written /verbal skills, problem-solving, and analytical skills.
  • Ability to lead and motivate others to execute a plan in a rapidly changing environment.
  • Ability to work collaboratively with health care professionals at all levels to achieve established goals and improve quality outcomes. Highly organized and ability to work autonomously.
  • Knowledge of leading practice in clinical care and payer requirements.
  • Ability to use Microsoft Office tools including Word PowerPoint, Excel, and Outlook.
  • EHR proficient.

Application Instructions

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