Description

• Develops and executes comprehensive population health strategies aligned with TMPN's organizational goals, value-based care contracts, and payer partnerships.
• Leads performance improvement across all HEDIS measures, including preventive care screenings (BCS, COL, CCS), chronic disease management (CDC, CBP, SPC, SPD), and medication adherence (PDC) measures.
• Design and implement care gap closure initiatives, including systematic patient outreach campaigns, provider education, clinical workflow optimization, and point-of-care interventions.
• Drives CMS Star Rating performance through strategic planning, measure-level analysis, and cross-functional improvement efforts.
• Monitors CMS, NCQA, and other regulatory changes to quality measurement programs and adapt organizational strategies accordingly.

• Leads TMPN's Hierarchical Condition Category (HCC) capture and Risk Adjustment Factor (RAF) optimization programs across all Medicare Advantage and risk-based populations.
• Develops and executes annual HCC recapture strategies, including provider education on documentation specificity, condition recapture workflows, and coding accuracy initiatives.
• Oversees HCC coding auditing and monitoring programs to ensure accurate capture of patient acuity and clinical complexity in all encounters.
• Implements systematic processes for prospective and retrospective chart review, documentation improvement, and coding quality validation.
• Monitors CMS risk adjustment methodology changes (V24/V28 model transitions) and adjust organizational strategies proactively.

• Builds and oversees TMPN's population health data and analytics infrastructure, including dashboards, performance reports, and predictive analytics capabilities.
• Develops provider-level, clinic-level, and network-level performance scorecards that track quality measures, HCC capture rates, RAF scores, and care gap closure metrics.
• Leverage data from EMR systems (Epic/Cerner), health plan portals, claims data, and other sources to identify trends, forecast performance, and drive decision-making.
• Designs and executes risk stratification models to identify high-risk patients for targeted interventions, care management referrals, and proactive outreach.

• Directly manages and develops a team of managers and analysts across population health, HCC/RAF, and data analytics functions.
• Presents population health performance, strategic recommendations, and operational updates to senior leadership, medical staff committees, and health plan partners.
• Serves as a key liaison between TMPN operations and physician leadership on quality performance, risk adjustment, and population health initiatives.
• Manages departmental budgets, vendor relationships, and resource allocation to maximize return on population health investments.

• Bachelor’s degree in Healthcare Administration, Public Health, Health Informatics, Business Administration, or related field required.
• Master's degree in Business Administration (MBA), Public Health (MPH) or Health Administration (MHA), strongly preferred.
• Minimum of seven (7) years of progressive experience in population health management, healthcare quality, or value-based care operations.
• Minimum of five (5) years in a leadership role and management of a team or personnel.
• Demonstrates expertise in HEDIS measures, CMS Star Ratings, and value-based care quality programs.
• Experience in HCC/RAF optimization, risk adjustment strategy, and coding compliance
• Experience with healthcare data analytics, performance reporting, and population health technology platforms.
• Experience in physician practice, ambulatory care, or medical group management setting strongly preferred.

• Strong understanding of CMS quality programs, NCQA HEDIS specifications, Star Ratings methodology, and value-based care contract structures.
• Expert knowledge of HCC coding, CMS-HCC risk adjustment models (V24/V28), RAF score calculation, and RADV compliance requirements.
• Strong proficiency with healthcare analytics tools, EMR reporting modules (Epic/Cerner), and business intelligence platforms.
• Experience with SQL, data visualization tools, or health analytics platforms for population-level reporting.

• Excellent written and verbal communication skills with ability to present complex data and clinical quality concepts to diverse audiences including executive leadership, physicians, and frontline staff.
• Strong relationship-building skills with physicians, health plan partners, and cross-functional operational teams.
• Proven ability to influence clinical practice through education, data-driven recommendations, and collaborative problem-solving.
• Experience in building, developing, and retaining high-performing teams in healthcare operations.

• Experience with Lean/Six Sigma methodology in healthcare quality improvement (certification a plus).
• Experience in managing population health programs for Medicare Advantage populations of 10,000+ members.
• Strong background in predictive modeling and advanced analytics for patient risk stratification
• Familiarity with behavioral science approaches patient outreach and engagement.

Salary Range: $142,438.00 - $247,728.00 per year                                                         #LI-CS1