CareFirst Careers

PCMH Pediatric Practice Consultant

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Resp & Qualifications

GENERAL SUMMARY:

CareFirst is a not-for-profit corporation which is the largest health insurer in the mid-Atlantic region with more than 3 million Members, 4,500 associates and more than $8 billion in annual revenue.  The company is regarded as a top employer in many surveys and offers competitive salary and benefits. 

Much different from other such programs, CareFirst launched its Patient-Centered Medical Home (PCMH) Program in 2011 and currently has more than 4,000 participating primary care providers organized into over 400 Panels.  Nearly $5 billion in global health care cost is managed by the Program on an annual basis.  With 7 full performance years complete, the Program has produced savings (actual cost vs. expected cost) every year.

The PCMH Program Consulting team consists of more than 30 individuals with varying educational and work backgrounds.  We have individuals who hold MPHs, MBAs, MHAs, and MPAs from a variety of leading universities.  Successful candidates come to CareFirst from provider organizations, business, government, advocacy organizations and other payers.

Given CareFirst’s presence in the region, the sophistication of the PCMH model and the substantial experience gained since 2011, this is the best opportunity in the market for individuals seeking to pioneer the development of the population health management field.

ROLE OF PCMH PEDIATRIC PRACTICE CONSULTANT: 

The primary role of the incumbent is to work closely with pediatricians enrolled in CareFirst’s Patient-Centered Medical Home (PCMH) Program to understand patterns in their population’s health data and effectuate practice transformation strategies that improve quality and manage the rate of growth in global health care costs.  This includes but not limited to:

  • ensuring pediatricians focus on the importance of the management of preventive / wellness care for children
  • ensuring pediatricians focus on the importance of appropriate management of routine illness in children
  • ensuring pediatricians focus on the importance of the intensive management of critically ill children in concert with the appropriate specialists and academic centers
  • influencing changes in referral patterns where appropriate
  • ensuring pediatricians’ understanding of impact on whole medical dollar
  • understanding need for active participation


The Practice Consultant partners with multiple Regional Care Directors, supports other Practice Consultants and collaborates with Local Care Coordinators, pediatricians, key physician practice staff, executive level health system administrators and other stakeholders to achieve program goals.

Following an extensive training program, Program Consultants are responsible for an assigned portfolio of PCMH Pediatric Panels (clients).  The typical Pediatric Practice Consultant is in a position to influence approximately $250 - $350 million in annual health care costs, through 30 – 50 Panels with approximately 300 – 500 pediatricians.

PRINCIPAL ACCOUNTABILITIES:

Under the general supervision of a Manager, PCMH Practice Consulting the incumbent’s accountabilities may include, but are not limited to, the following:

1. Panel Data Analysis

  • Becomes the expert in the portfolio of PCMH Panels assigned, keenly attuned to priority Panels’ current outcomes and areas of opportunity
  • Using CareFirst’s proprietary, purpose-built analytic system (known as SearchLight) with at least120 reports available for every panel, conducts a thorough review of Panel’s opportunities, utilization patterns, and outcomes on a monthly or quarterly basis. Acts as a subject matter expert for SearchLight reporting, effectively articulates data sources, data structures, data integrity, etc.
  • Track Panel performance on key metrics, develops Panel-specific plan to support maximum outcomes and adjusts as necessary
  • Researches any variances and seeks resolution
  • Demonstrates the ability to identify through the data, the practice patterns which if modified yield the biggest impact
  • Prepares findings in a format designed to tell a compelling story through the data and create the appropriate “call to action” from the target audience of Panel PCPs
  • Prioritizes Panels with greatest impact on overall results


2. Engagement with Panel and Practice Leadership on Practice Transformation Activities based on Findings from Data Analysis

  • Articulates the basic tenets of the PCMH Program and successfully presents to providers, administrators, and other key stakeholders.
  • Schedules, prepares for and facilitates customized presentations, articulating the call to action based on panel data
  • Maintains a strong relationship, a high level of contact and program direction with the Panel in order to implement practice transformation strategies indicated by the data analysis
  • Employs consulting skills to overcome objections and resistance to change from Panel PCPs, influencing a Panel to make a mutual decision to act on proposed practice transformation strategies
  • Develops deep relationships with management and key influencers in the Panel that enable the Program Consultant to be the catalyst for practice transformation
  • Motivates and inspires PCPs and their Panels to change behavior and improve overall quality through data analysis and consulting
  • Develops strong relationships with Local Care Coordination nurses embedded in the Practices to promote and assure continuity of practice transformation strategies in between Program Consultant visits
  • Focuses providers on findings with the greatest impact on overall quality – directs conversation to avoid low impact pursuits
  • Escalates as necessary




3. Active Participant in Corporate Meetings, Practice Consultant Team Activities and Administrative Functions

  • Manages priorities and exhibits the appropriate level of effort for each Panel to achieve maximum impact
  • Once fully trained, mentors and supports other Practice Consultants during training or absence as requested
  • Tracks key metrics for Panels and meets regularly with Regional Care Director and Local Care Coordinators to assess progress


QUALIFICATION REQUIREMENTS:

Required Experience/Skills/Abilities:

  • Master’s Degree in Public Health, Health Administration, Business Administration, or related field
  • At least 1-3 years of experience in the healthcare field, preferably in pediatric medicine
  • Experience to quality measurement programs
  • Demonstrated ability to effectively comprehend complex data analysis
  • Solution development
  • Executive  presentation skills
  • Effective written and interpersonal communication skills
  • Must be able to work independently with minimal oversight and demonstrate attention to detail, accuracy and quality awareness
  • Well organized, able to multi-task and exhibit flexibility
  • Proven analytical and problem solving skills
  • General understanding of operations, finance, health care systems
  • Ability to work in a matrixed organization, promoting collaboration and teamwork
  • Effective at building relationships with various levels of business professionals and/or clinicians
  • Drive to establish new relationships within healthcare provider community and be creative in coordinating meetings, overcoming obstacles to scheduling, etc.
  • Strong computer skills including Microsoft Excel, PowerPoint, Word, and Outlook.
  • Able to travel through assigned region on a daily basis and work in the field the majority of work days (75% of role is in the field)
  • Must have reliable transportation for travel between Corporate offices, provider/Panel offices and other locations as needed
  • Must be able to effectively communicate and provide positive customer service to every internal and external customer, including customers who may be demanding or otherwise challenging
  • Must demonstrate resilience and effectively work in a fast-paced environment with frequently changing priorities, deadlines, and workloads that can be variable for long periods of time 
  • Must be able to meet established deadlines and handle multiple customer service demands from internal and external customers, within set expectations for service excellence.  


Preferred:

  • Consulting skills and/or direct experience in a consulting role
  • Experience working in pediatric healthcare setting and/or within field of pediatric medicine
  • Experience working with industry-standard clinical quality measures such as NCQA, NQF or equivalent
  • Experience using Client Relationship Management (CRM) System(s)
  • Experience in a clinical setting or knowledge in a clinically related field
  • Project management experience

Department

Department: Patient-Centered Medical Home Program Consultants

Equal Employment Opportunity

CareFirst BlueCross BlueShield is an Equal Opportunity (EEO) employer.  It is the policy of the Company to provide equal employment opportunities to all qualified applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, protected veteran or disabled status, or genetic information.

Hire Range Disclaimer

Actual salary will be based on relevant job experience and work history.

Where To Apply

Please visit our website to apply: www.carefirst.com/careers

Closing Date

Please apply before: 4/26/2018

Federal Disc/Physical Demand

Note:  The incumbent is required to immediately disclose any debarment, exclusion, or other event that makes him/her ineligible to perform work directly or indirectly on Federal health care programs.

PHYSICAL DEMANDS:

The associate is primarily seated while performing the duties of the position.  Occasional walking or standing is required.  The hands are regularly used to write, type, key and handle or feel small controls and objects.  The associate must frequently talk and hear.  Weights of up to 25 pounds are occasionally lifted.

Sponsorship in US

Must be eligible to work in the U.S. without Sponsorship

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