Director, Population Health
Directs educational programs, pilots, projects and tools designed to improve clinical utilization/authorization for VNSNY field staff and managed care organizations. Oversees clinical utilization assessments and makes recommendations for improvements/revisions based on inter-professional best practices and evidence-based practices. Works under general supervision.
Provides overall analysis and summary of enterprise data for clinical utilization management and identifies trends for Provider Services management teams and managed care organizations.
Serves as a resource and consultant to the regions regarding clinical utilization management. Assists in the preparation of financial summaries of episodic payer utilization, analyzes trends and best practices, and works with regional management to spread these practices throughout the regions.
Collaborates with department and business operations management around streamlining authorization processes and revision of workflows to promote positive patient outcomes while managing clinical utilization, optimizing appropriate reimbursement and ensuring compliance. Identifies areas for improvement; recommends and implements changes.
Ensures adherence to regulatory issues and standards of practice.
Collaborates with Clinical Education to identify training needs and activities for staff that focus on accurate and appropriate evidence based practice principles, existing tools and guidelines, and guideline software applications.
Collaborates with Clinical Education on “train the trainer” programs to ensure standardized training for new and incumbent staff.
Researches literature with team around emerging evidenced based practice guidelines for service level approvals and authorizations and guidance to clinicians.
Collaborates with Quality Management to evaluate the effectiveness of workflows and targeted training for clinical utilization. Makes recommendations for changes/improvements as needed.
Performs all duties inherent in a managerial role. Ensures effective staff training, evaluates staff performance, provides input for the development of the department budget, and hires, promotes and terminates staff and recommends salary actions, as appropriate.
Participates in special projects and performs other duties as assigned.