About Montana Health Plus Montana Health Plus is a Clinically Integrated Network and an Accountable Care Organization (ACO) participating in the Medicare Shared Savings Program. While administered in partnership with the Montana Primary Care Association, Montana Health Plus is governed by its own Board of Directors, composed of leaders from Community Health Centers across the state. Its purpose is to improve population health through a formal statewide system of care — strengthening clinical outcomes and lowering overall healthcare costs for Montanans regardless of income or coverage status, with integrated, patient-centered care delivered through a network of community-based health centers. Position Summary The Practice Transformation Coach serves as a strategic advisor and hands-on facilitator to Community Health Centers participating in Montana Health Plus's value-based care contracts. As part of a small, statewide team, the Coach works across the full breadth of value-based care performance — clinical quality improvement, workflow redesign, care-gap closure, and data-informed practice change. The Coach divides time between population health data analysis and direct clinic facilitation, partnering with multidisciplinary care teams and providers to build each health center's own capacity for sustainable improvement. This position is employed by the Montana Primary Care Association and funded through Montana Health Plus.

Essential Duties and Responsibilities Value-Based Contract Performance:

Support participating health centers in meeting the quality, utilization, and documentation measures of Montana Health Plus's value-based contracts, including the Medicare Shared Savings Program and Montana Medicaid's Primary Care Montana (PCMT) program — with emphasis on Annual Wellness Visits, Transitions of Care, post-hospitalization follow-up, and chronic disease management.

Data-Driven Improvement:

Analyze network- and clinic-level population health data (including Azara DRVS dashboards and payer reporting) to identify performance gaps, documentation and coding accuracy opportunities, and missed preventive screenings; translate findings into clear, prioritized improvement plans with each health center.

Workflow Redesign and QI Coaching:

Partner with health center care teams to apply Plan-Do-Study-Act (PDSA) rapid-cycle improvement methods, embedding care-gap closure and quality measures into daily clinical workflows. The Coach builds clinic capacity as a trainer and facilitator — developing the team's own ability to sustain change — rather than performing the work on the clinic's behalf.

Patient Engagement Support:

Support health centers in designing and implementing proactive patient outreach workflows, pre-visit planning, and patient-centered engagement strategies (including team-based use of Motivational Interviewing approaches) to reach high-risk populations. This position does not provide direct patient care.

EHR and Registry Optimization:

Assess and align Electronic Health Record configurations, templates, and clinical registries across participating health centers (including athenahealth, Epic, eClinicalworks, NextGen, and Oracle Health/Cerner platforms) to streamline clinical documentation, quality reporting, and alignment with UDS clinical quality measures.

Peer Learning Facilitation:

Design and facilitate peer learning forums, webinars, and regional peer-to-peer sessions that spread effective practices across the network and strengthen relationships among health center quality teams.

Relationship Building:

Build and maintain trust-based, collegial relationships with health center leadership, providers, and care teams statewide — meeting each health center where it is and driving change that lasts beyond any single engagement. Other duties as assigned by the Executive Director of Montana Health Plus. Minimum Qualifications Bachelor's degree in healthcare administration, public health, nursing, or a related field, or equivalent combination of education and experience Three (3) or more years of experience in clinical practice transformation, ambulatory quality improvement, or healthcare operations in a value-based care or ACO environment Direct experience working within or supporting Federally Qualified Health Centers, including working knowledge of HRSA requirements and UDS clinical quality measures Proficiency with population health management platforms and ambulatory EHR systems (e.g., athenahealth, Oracle Health/Cerner); experience with Azara DRVS strongly preferred Experience with NCQA Patient-Centered Medical Home elements and recognition Ability to travel statewide, including regular overnight travel to rural communities (approximately 30-40%); valid driver's license required Preferred Qualifications Experience supporting Medicare Shared Savings Program, Medicaid value-based or primary care case management programs (such as Primary Care Montana), or other ACO contract performance Industry certification such as Certified Professional in Healthcare Quality (CPHQ), Lean/Six Sigma, or Project Management Professional (PMP) Training or facilitation experience in Motivational Interviewing or patient engagement methods Core Competencies Relationship building and facilitation — earns trust quickly with clinical and operational staff at every level Data literacy — moves fluently between dashboards and the exam-room workflows behind them Adaptability — tailors approach to health centers of varying size, resources, and readiness Self-direction — manages a statewide portfolio independently from a remote home base Commitment to the Community Health Center mission and to health equity for rural and underserved Montanans Working Conditions and Physical Requirements Remote work environment within Montana, with prolonged periods at a computer, monitor, and keyboard and occasional lifting of lightweight materials. Regular statewide travel to member health centers, including rural communities, is required, with regular overnight travel [estimate: 30-40%]. A valid driver's license is required. Reasonable accommodations may be made to enable individuals with disabilities to perform essential functions. Please apply on the MPCA website directly, and include resume and cover letter.

Pay:

$78,000.00 - $95,000.00 per year

Benefits:

401(k) Dental insurance Health insurance Life insurance Paid time off Retirement plan

Work Location:

Hybrid remote in Helena, MT 59601