Practice Integration Rep-PCCN

Position Details

Department: PCCN | Phx Children's Care Network
Category: PCCN
Location: Telecommuting
Employee Type: Regular
Posting #: 685893
Posted On: 7/14/2022

Position Summary

This position is responsible for developing and maintaining cooperative working relationships with administrators and providers in the Phoenix Children’s Care Network (PCCN). Through working with network stakeholders (payers and providers), this position is responsible for ensuring that all contractual, operation, financial, and clinical integration requirements are adhered to and achieved through quality improvement initiatives, provider education, best practice development, provider training, collaborative problem solving and trend identification.

Position Duties

  1. Provider Network Operations
    • Researches and resolves incoming escalated provider inquiries within contract guidelines; educates providers on new protocols, quality metrics, clinically integrated organizational protocols, organizational policies, and procedures.
    • Serves as a liaison between aligned payers and practices (and escalates to leadership when necessary) by effectively communicating practice issues and needs to payers when applicable to CIN goals, mission and vision.
    • Researches and resolves network, quality, and administrative conflicts in a timely manner
    • Communicates and works with Business Operations Analyst to ensure that practices received important payer notifications through direct communication with the practice and through PCCN’s OneDrive file repository.
    • Understands and can explain PCCN’s contractual obligations quality metrics, financial metrics, and shared savings and quality bonus distribution model to network stakeholders in detail
    • Schedules and attends visits with identified PCCN practice administrators including providers, nurses, referral coordinators, practice managers and other office staff at clinics in assigned territory to establish relationships.
    • Takes a proactive approach to relationship building to ensure active outreach and coordination of schedules with network providers. Including but not limited to sending all necessary materials and agenda prior to scheduled meetings, promptly re-schedules visits if necessary, and sending appointment reminders as needed
    • Performs periodic audits and review of network quality measures and practices to ensure adherence to network protocols and adopted clinical guidelines. Through this process, this position investigates and communicates discrepancies to internal stakeholders, participates in monthly evaluation of Network Quality performance, and communicates community feedback specific to quality performance concerns to administrative and analytics leadership.
    • Coordinates and facilitates of specialty educational series, faculty learning collaboratives, network town halls, committees, and other PIT related events.
    • Distributes PCCN scorecards, ED utilization, patient panel and ICC referrals with practice monthly and ensures understanding of data and opportunities for closing gaps
  2. Quality Improvement
    • Assists with the development and implementation of provider training programs, including but not limited to HEDIS and quality metric performance. This work includes but is not limited to serving as the main PCCN provider training resource, contribution in developing monthly agenda, assisting with surveys and data analysis, develops work flow in accordance with best practices, encourages participation in QI programs, and assists with MOC credit award process.
    • With support of data from the analytics team, monitors and analyzes Quality Improvement (QI) outcomes and trends to ensure network goals, objectives, outcomes, accreditation and regulatory requirements are met. This position meets monthly with operations, quality, and analytics to assess Network progress, intervene and assist with data discrepancies at the practice level, evaluate member alignment in collaboration with community providers, and updates and maintains Network OneDrive with all corresponding documentation
    • Messengers new contracting opportunities and contract amendments in PCCN value-based agreements by disseminating contract specifics to community providers through DocuSign, communicating details through Practice Integration visits, facilitating payer focused Town Halls, ensures accuracy of assigned delegates at each practice, and ongoing tracking of returned contracts.
    • Regularly gather provider adds and termination information from participating practices and communicates those changes to the Business Operations Analyst
    • Is familiar with and understands URAC Clinical Integration requirements and what those requirements mean to the Practice Integration team. Will contribute to URAC accreditation through “secret shopper” calls, policy creation and maintenance, and contribution to URAC audits.
    • Acts as an agent of change in the network and communicates the vision for change by sharing best practices and clinical pathways to support improved patient care, patient/provider satisfaction, population health and appropriate utilization of healthcare resources.
  3. Administrative Functions
    • Works independently to schedule time with practices and adheres to the schedule or updates as necessary in a transparent fashion.
    • Documents encounters with each practice in SalesForce within one business day to maintain up-to-date, accurate, and complete visit details. These details include but are not limited to: meeting notes, emails, issues or concerns, participation in QI projects, escalation to PCH Physician Relations (for PCH related issues) and awarding of engagement points.
  4. Performs miscellaneous job related duties as requested.

Phoenix Children's Mission, Vision, & Values

Mission

To advance hope, healing and the best healthcare for children and their families

Vision

Phoenix Children's will be the leading pediatric health system in the Southwest, nationally recognized for exceptional care, innovative research and advanced medical education.

We realize this vision by:

  • Offering the most comprehensive care across ages, communities and specialties
  • Investing in innovative research, including emerging treatments, tools and technologies
  • Advancing education and training to shape the next generation of clinical leaders
  • Advocating for the health and well-being of children and families
Values
  • We place children and families at the center of all we do
  • We deliver exceptional care, every day and in every way
  • We collaborate with colleagues, partners and communities to amplify our impact
  • We set the standards of pediatric healthcare today, and innovate for the future
  • We are accountable for making the highest quality care accessible and affordable
The position has been closed or filled.

Please search our career site for positions that are currently active and accepting resumes at https://careers.phoenixchildrens.com