Population Health Specialist, Senior

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Estimated Hiring Range:

Bonus Target:

Current CareOregon Employees: Please use the internal Workday site to submit an application for this job.

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Essential Responsibilities

Programs & Initiatives

• Develop and oversee high-impact population health initiatives that align with organizational and Medicaid/Medicare objectives.
• Lead the development and execution of innovative member engagement programs to improve care coordination and access to preventive care.
• Lead and manage complex population health initiatives from inception to completion, ensuring strategic alignment with organizational goals; initiatives may span across multiple geographies.
• Develop and oversee project timelines, key milestones and success metrics to measure impact.
• Proactively identify potential risks and barriers; develop mitigation strategies to keep projects on track.
• Collaborate with cross-functional teams and leadership to drive project execution and ensure seamless implementation.
• Monitor program performance, propose and implement adjustments based on healthcare performance metrics and data insights.
• Monitor and assess the impact of population health initiatives through metrics, reporting and continuous improvement.
• Lead development and implementation of strategies to address cost, utilization and quality of care; support reduction of health disparities among vulnerable populations.
• Maintain project documentation and deliver regular status updates to leadership and invested parties.

Partnerships

• Establish and strengthen partnerships with healthcare providers, community organizations and other stakeholders to drive collaboration.
• Lead in the communication and translation of population health strategies, priorities, best practices and updates.
• Lead the discussion on workflow optimization including process evaluation, identification of bottlenecks and inefficiencies and areas of improvement.
• Resolve barriers to meeting key population health priorities through high-level leadership meetings with the line of business and departments.
• Research population health approaches and market practices and provide recommendations in partnership with content experts and multiple stakeholders; work to integrate programs and strategies across multiple LOBs.
• Design and lead collaborative meetings with internal and external partners to identify opportunities and implement interventions that improve quality, utilization and health outcomes.
• Represent the organization in statewide learning collaboratives related to population health projects.
• Provide guidance and direction to mid-level positions.

Technical Expertise & Assistance

• Lead training and orientation efforts for internal teams and partners on advanced population health strategies, best practices and self-service data utilization as needed.
• Provide technical assistance to support operationalization of complex projects that may include education and training, addressing staffing models, workflows, documentation support, data collection, monitoring/evaluation approaches and referral relationships.
• Serve as a senior subject matter expert in population health, offering thoughtful guidance and data-driven recommendations for program and systems improvement.
• Translate complex data insights and provide actionable strategy recommendations to guide decision- making and support organization-wide department implementations.
• Provide data-informed recommendations for targeted interventions to improve cost efficiency and optimize care delivery.
• Mentor junior staff and contribute to capacity-building, consultative and prioritization efforts across the population health team.

Reporting

• Lead the review and interpretation of existing dashboards and reports to analyze healthcare utilization trends, cost drivers and quality care gaps.
• Interpret and report on healthcare quality metrics such as HEDIS, NCQA, CMS Star Ratings and CCO performance measures.
• Develop reports and presentations and communicate findings and strategic recommendations to leadership and key invested parties.
• Collaborate with data teams to refine reporting tools and ensure data accuracy and relevance for population health initiatives.
• Ensure organizational compliance with Medicaid, Medicare and state-specific healthcare regulations and reporting requirements.

Experience and/or Education

Required

• Minimum 6 years’ experience in population health, public health, health care management, quality improvement or a related field
• Minimum 1 year of experience implementing population health initiatives within a managed care organization or a health care delivery system
• Minimum 1 year of experience utilizing data to identify trends and make recommendations that lead to action
• Experience must include at least 2 years with one (or more) of the following:
  • Working with Medicaid/Medicare populations 
  • Leading complex improvement projects with multiple invested parties 
  • Implementing programs/projects and creating effective monitoring/evaluation systems
  • Working with data from populations that have elevated health risks, complex care needs or unique life circumstances 
  • Analyzing cost and utilization (e.g., cost drivers, areas for increased efficiency, etc.)

Preferred

• Experience utilizing health care data to drive recommendations and program design
• 2 years’ experience working within a managed care organization/CCO in Oregon

Knowledge, Skills and Abilities Required

Knowledge

• Advanced knowledge of Medicaid and Medicare programs, regulations, and managed care operations
• Advanced knowledge of managed care operations and systems thinking
• Deep knowledge of quality improvement methodologies and healthcare performance metrics (e.g., HEDIS, NCQA, CMS Star Ratings, CCO metrics)
• Deep understanding of cost drivers, utilization patterns, and strategies to manage medical spending across populations.
• Understanding of social determinants of health (SDOH) and strategies for addressing health inequities

Skills and Abilities

• Advanced experience with interpreting and analyzing healthcare data from dashboards and reports (e.g., Tableau, Excel, or similar tools)
• Advanced experience in evaluating health care resource utilization and recommending strategies to reduce unnecessary or avoidable utilization
• Advanced ability to use Excel functions for manipulating, analyzing, and visualizing population and claims data
• Strong ability to provide data-driven insights and recommendations based on trends, utilization patterns, and cost analysis
• Strong project management skills with the ability to lead large-scale, concurrent initiatives across multiple teams
• Strong ability to establish and maintain strong partnerships with healthcare providers, community organizations, and key stakeholders
• Excellent communication and presentation skills; strong ability to translate complex data into  actionable and strategic insights
• Strong ability to work independently and collaboratively in a fast-paced, mission-driven environment
• Strong ability to effectively collaborate with and lead colleagues and multiple internal and external groups,
• Strong ability to take initiative and proactively identify tasks and projects without needing direction
• Strong ability to provide functional and technical input to CareOregon teams and external partner organizations to advance and support CareOregon programs, goals, objectives, and outcomes
• Strong analysis, quantitative reasoning, and creative problem-solving skills
• Strong leadership, consensus building, and strategic planning skills
• Ability to apply process improvement principles and approaches
• Ability to work effectively with diverse individuals and groups
• Ability to learn, focus, understand, and evaluate information and determine appropriate actions
• Ability to accept direction and feedback, as well as tolerate and manage stress
• Ability to see, read, and perform repetitive finger and wrist movement for at least 6 hours/day
• Ability to hear and speak clearly for at least 3-6 hours/day

Working Conditions

Work Environment(s):         ☒ Indoor/Office    ☐ Community      ☐Facilities/Security                   ☐ Outdoor Exposure

Member/Patient Facing:     ☒ No                        ☐ Telephonic       ☐ In Person

Hazards:  May include, but not limited to, physical and ergonomic hazards.

Equipment:  General office equipment

Travel:  May include occasional required or optional travel outside of the workplace; the employee’s personal vehicle, local transit or other means of transportation may be used. 

Work Location: Work from home

We offer a strong Total Rewards Program. This includes competitive pay, bonus opportunity, and a comprehensive benefits package.  Eligibility for bonuses and benefits is dependent on factors such as the position type and the number of scheduled weekly hours. Benefits-eligible employees qualify for benefits beginning on the first of the month on or after their start date. CareOregon offers medical, dental, vision, life, AD&D, and disability insurance, as well as health savings account, flexible spending account(s), lifestyle spending account, employee assistance program, wellness program, discounts, and multiple supplemental benefits (e.g., voluntary life, critical illness, accident, hospital indemnity, identity theft protection, pre-tax parking, pet insurance, 529 College Savings, etc.). We also offer a strong retirement plan with employer contributions. Benefits-eligible employees accrue PTO and Paid State Sick Time based on hours worked/scheduled hours and the primary work state. Employees may also receive paid holidays, volunteer time, jury duty, bereavement leave, and more, depending on eligibility. Non-benefits eligible employees can enjoy 401(k) contributions, Paid State Sick Time, wellness and employee assistance program benefits, and other perks. Please contact your recruiter for more information.

We are an equal opportunity employer

CareOregon is an equal opportunity employer.  The organization selects the best individual for the job based upon job related qualifications, regardless of race, color, religion, sexual orientation, national origin, gender, gender identity, gender expression, genetic information, age, veteran status, ancestry, marital status or disability. The organization will make a reasonable accommodation to known physical or mental limitations of a qualified applicant or employee with a disability unless the accommodation will impose an undue hardship on the operation of our organization.