Senior Manager, Gaps in Care

November 22, 2016

Senior Manager, Gaps in Care

The UAW Retiree Medical Benefits Trust (the “Trust”) is located in Detroit, Michigan.  We are currently seeking an experienced health care professional to fill the Senior Manager for Gaps in Care position. This position  is responsible to develop, execute, and evaluate the Gaps in Care program which addresses and closes gaps in care for the Trust membership through the process of leveraging the capabilities of associated health care delivery Partners[1].  This is an integral leader at the Trust in making a positive difference in our member's lives by ensuring they receive high quality care and improve clinical outcomes by eliminating gaps in care where they exist.

Essential Duties and Responsibilities:

  • Using Trust data (Truven, Verscend), perform evaluations of preventive care and clinical practice guideline adherence
  • Identify gaps in care for prevention, early detection, and management of chronic disease conditions for high risk and prevalent diagnoses in the Trust membership
  • Analyze specific segments of the population as appropriate such as age, gender, marital status, geography, newly retired Trust enrollees, etc.
  • Based on the Trust member data, design and lead a comprehensive program for closure of care gaps that establishes short and long term program goals, tasks, and progress measurement; assure that program activities are scalable, sustainable, repeatable, and automated
  • Design and develop activities to address key gaps that include, but are not limited to:
  • Missing professional services such as physician office visits
  • Chronic disease monitoring and management (lab and other tests)
  • Medication adherence
  • Appropriate age related preventive care and screening services
  • Assess healthcare delivery Partner capabilities to execute meaningful gap closure activities; map gap closure opportunities with appropriate partners
  • Secure leadership and multidisciplinary team consensus on identified gaps in care and prioritization of closure strategies
  • Establish expectations with healthcare delivery Partners for gap closure activities including goals, timelines, and deliverables
  • Work closely with other Trust departments and leadership to communicate and hold health care delivery Partners responsible for effective progress on reducing gaps in care for the members they serve
  • Where an appropriate Partner is not identified to intervene on gaps, work within the Trust to develop proactive member outreach and communications designed to encourage members to obtain needed services  
  • Develop performance measurement reports; incorporate current gap closure trends and use evidence based literature data to benchmark Trust performance and improved quality of care

Qualifications:

The ideal candidate will possess a unique combination of healthcare related business acumen, research and project management experience, with an ability to balance all three.

Minimum Qualifications:

  • Bachelor’s degree
  • A minimum of five years of work experience in healthcare, pharmacy, public health, or related field
  • Ability to work independently to organize, plan, and execute projects effectively
  • A self-starter who can deliver results through creative solutions
  • Demonstrate strong written, and verbal communication skills including the ability to work with internal and external business partners to meet mutual goals
  • Knowledge and experience working with data from clinical data warehouse systems, including HEDIS or HEDIS-like metrics to measure performance on important dimensions of care and service   
  • Ability to demonstrate enthusiasm and maintain an optimistic demeanor through the lifecycle of a project
  • Must be able to use the following applications without assistance: Word, Excel, and PowerPoint; must have experience conducting healthcare related internet research and interpreting clinical practice guidelines

 

Preferred Qualifications:

  • Master’s degree in healthcare, or related field
  • Demonstrated experience in the research and development of clinical program design, project management, analysis and outcomes planning and execution
  • Experience working with a retiree population or possess geriatric care experience

 

Qualified candidates please forward your resume along with salary requirements to: kblair@rhac.com




[1] Healthcare delivery partners include but are not limited to: Vendors = Pharmacy Benefits Manager, Behavioral Health Vendor; Carrier = Self and Fully Insured Carriers, Vision and Dental