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Population Health Officer

hace 4 días

Miami

Job DescriptionPalm is a physician-led primary care medical group with a growing presence across Florida and North Texas. Our model is centered on delivering high-quality, value-based care with a strong emphasis on patient outcomes, provider satisfaction, and operational excellence. As a group operating across Medicare Advantage, Medicaid, ACA, and commercial populations under both risk-based and fee-for-service contracts, we are focused on building a scalable, high-performing platform that aligns clinical quality, patient experience, and financial performance. Position Overview The Population Health Officer (the “PHO”) reports to the CEO and serves as the senior executive leader responsible for total cost of care performance, utilization management, and population health strategy across Palm’s markets. This role defines what care should happen at a system level—establishing priorities, care models, and intervention strategies to improve outcomes, reduce avoidable utilization, and optimize value-based performance. Success in this role requires the ability to translate data and financial performance into actionable care strategies executed across clinical and operational teams. Interaction with the provider team is critical and will require frequent local travel between clinics. Unlike the COO (who executes care delivery) and the CMO (who defines clinical standards), the PHO defines population-level care priorities and medical cost strategy. Key Responsibilities Population Health Strategy & Total Cost of Care • Own enterprise performance for total cost of care (TCOC) across all markets and payer arrangements, • Define and execute population health strategies to improve outcomes while reducing avoidable utilization, • Develop multi-level intervention strategies targeting high-risk, rising-risk, and general populations, • Monitor in-year performance (PMPM) and implement corrective actions to address cost and utilization trends Utilization Management & Medical Cost Control, • Establish utilization management standards, escalation thresholds, and decision frameworks, • Own medical management programs, including prior authorization strategy and referral optimization, • Identify drivers of avoidable utilization (ED, inpatient, post-acute) and implement targeted interventions, • Partner with clinical leadership to ensure utilization strategies are clinically appropriate and effective Care Management & Transitions of Care, • Responsible for care management programs, including case management, disease management, and care coordination, • Design and implement transitions of care strategies to reduce readmissions and improve post-acute outcomes, • Ensure appropriate deployment of care managers, social workers, and support resources, • Drive measurable improvements in patient outcomes through longitudinal care programs Risk Stratification & Cohort Management, • Define risk stratification methodologies and cohort prioritization frameworks, • Identify high-impact patient segments and align resources accordingly, • Establish proactive outreach and intervention models for high-risk populations, • Continuously refine targeting strategies using analytics and performance data Value-Based Performance & Payor Outcomes, • Drive performance across value-based contracts, including cost, quality, and utilization metrics, • Partner with Finance and Managed Care to align medical cost strategies with financial performance goals, • Support payor performance initiatives (excluding contract negotiation and reconciliation ownership), • Ensure readiness for delegation and performance accountability in risk-based arrangements Cross-Functional Leadership & Alignment, • Partner with the Chief Medical Officer to ensure care models and utilization strategies are clinically sound, • Collaborate with the COO to align population health priorities with operational execution in clinics, • Work closely with analytics, finance, and managed care teams to monitor performance and refine strategies, • Defines what care should happen and where to prioritize resources, • Owns population health strategy and intervention design, • Accountable for total cost of care performancePrimary Accountability, • Management of Total cost of care (TCOC), • Accountable for medical cost performance under risk-based contracts, • Utilization management, • Care management and transitions of care, • Risk stratification and cohort prioritizationExplicitly Does NOT Own, • Clinic staffing, scheduling, or operations, • Facility or infrastructure decisions, • Direct management of clinic staff (outside care management), • Payor contract negotiationAuthority / Assistance, • Defines care models required for risk success, • Sets utilization standards and targets, • Determines care priorities and intervention focus areasKey Performance Indicators (KPIs), • Financial: Total cost of care (TCOC), PMPM performance, medical cost trends, • Utilization: ED visits, inpatient admissions, readmissions, post-acute utilization, • Clinical: Quality outcomes, care gap closure, chronic disease management, • Population Health: Risk stratification effectiveness, intervention impact, cohort performance, • Utilization Management leadership, • Care Management teams, • Population Health analytics resourcesKey Partnerships, • CEO, COO, CFO, • Chief Medical Officer and market leadership, • Managed Care Officer, • Clinic operations team, • Master’s in Public Health, healthcare Administration, clinical/healthcare degree, or related field preferred, • 10+ years of experience in population health, medical management, or value-based care leadership, • Deep understanding of Medicare Advantage and risk-based care models, • Experience managing total cost of care and utilization performance in capitated or shared-risk environments, • Strong analytical and data-driven decision-making skills, • Proven ability to design and implement population health strategies at scale, • Demonstrated success working cross-functionally with clinical and operational leaders, • Establish credibility with executive leadership, clinical leaders, and operational teams, • Develop a clear baseline view of total cost of care and utilization performance across markets, • Identify key drivers of avoidable utilization and define initial intervention priorities, • Implement or refine risk stratification and cohort targeting strategies, • Align care management and utilization programs with defined population health priorities, • Establish performance dashboards and operating cadence for population health metrics, • Begin driving measurable improvements in utilization trends and in-year cost performanceWhy Join Us, • Executive leadership role with direct impact on clinical outcomes and financial performance, • Opportunity to shape and scale a high-performing population health platform, • Physician-led, mission-driven organization focused on value-based care, • Collaborative executive team with strong growth trajectory Palm is an equal opportunity employer that is committed to diversity and inclusion in the workplace. We prohibit discrimination and harassment of any kind based on race, color, sex, religion, sexual orientation, national origin, disability, genetic information, pregnancy, or any other protected characteristic as outlined by federal, state, or local laws. This policy applies to all employment practices within our organization, including hiring, recruiting, promotion, termination, layoff, recall, leave of absence, compensation, benefits, training, and apprenticeship. Palm makes hiring decisions based solely on qualifications, merit, and business needs at the time. Powered by JazzHR yCs4kCxSR3

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