Admin, Reg Strat & Value Mgmt

JOB DESCRIPTION: This role is a critical adjunct to developing approaches for Physician Group Practice compliance with regulatory requirements from government payers, and the coordination of these approaches with those of managed care contracts and other pay-for-performance and pay-for-improvement programs. Additionally, as resource utilization becomes an increasingly important measure of value, this role will assist in measuring, and managing cost across the physician group practice enterprise. In order to appropriately execute the transformation to population health management and the business model changes suggested by regulatory and payment method changes, this leader will need to be in a senior leader position overseeing the EHC data and analytics team and infrastructure, as applicable to physician group practice data. Reports to the Chief Medical Officer for Emory Clinic and Emory Specialty Associates. Collaborates with Office of Quality, Analytics Group for EHC, Office for Contracting and Payer Relationships, Emory Health Network Leadership Group.

This administrator will assist in the development of the Physician Group Practice strategy to approach the newest reimbursement models from CMS, including but not limited to Medicare Access and CHIP Reauthorization Act of 2015 (MACRA): Merit-based Incentive Payment System (MIPS), Alternative Payment Models (APMs), and physician-focused payment model (PFPMs). These programs are affected by patient attribution, quality reporting, patient satisfaction and resource use, all of which need to be assessed and managed as the programs move forward. Additionally, there will a need to coordinate with the requirements for Medicaid and state payer methodology. Approaches for these programs will need to be synergistic with the approaches to Managed Care contracts. This administrator will be responsible for creating the communication venues and discussion forums for leadership to address this domain.

The Administrator for Regulatory Strategy and Value Management is responsible for creating the methodology for measuring, monitoring and improving resource utilization across the physician practices. This will include cost of care to patients, payers and the internal system. This will necessitate use of benchmarking, comparative analytics and coordination with supply chain and clinical teams.

This administrator will be accountable for creating the infrastructure for quality reporting, coordinating with the Office of Quality and Office of contracting for the multiple submissions to various entities, and executing the submissions of data and/or provider attestations. The administrator will be responsible for knowledge acquisition and dissemination regarding timelines, deadlines and exemption availability. A goal for this administrator will be to perform cost/benefit analyses of various methods of participation in these programs to advise leadership on best approaches.

Collaborating with the Chief Research Information Officer, Emory University School of Medicine, Medical Director for Analytics, Emory Healthcare, this administrator will be responsible for development of the structure for Physician Group Practice analytics, recruitment, training and coaching of the team members, and coordination of the work product of this group. This work product will be defined and refined by the administrative, management and clinical needs of the Physician Group Practice.

MINIMUM QULIFICATIONS: Bachelor's degree in business administration, finance, healthcare administration, or related field required. Master's degree preferred. With bachelor's, minimum of seven (7) years healthcare related experience, ambulatory setting preferred; With master's, minimum of five (5) years healthcare related experience, ambulatory setting preferred. Minimum requirement of three (3) years supervisory/manager experience. TEC Management Development Plan graduate can satisfy all experience qualifications.

PHYSICAL REQUIREMENTS: 1-10 lbs 0-33% of the work day (occasionally), negligible 34-66% of the workday (frequently), negligible 67-100% of the workday (constantly). Lifting 10 lbs max, carrying of small articles such as dockets, ledgers, files, small tools, occasional standing & walking, frequent sitting, close eye work (computers, typing, reading, writing), Physical demands may vary depending on assigned work area and work tasks.

ENVIRONMENTAL FACTORS: Factors affecting environment conditions may vary depending on the assigned work area and tasks. Environmental exposures include, but are not limited to: Blood-borne pathogen exposure, Bio-hazardous waste. chemicals/gases/fumes/vapors, communicable diseases, electrical shock, floor surfaces, hot/cold temperatures, indoor/outdoor conditions, latex, lighting patient care/handling injuries, radiation, shift work, travel may be required, use of personal protective equipment, including respirators, environmental conditions may vary depending on assigned work area and work tasks.