Category: MM Curator

Clipped from: https://vhr-otsuka.wd1.myworkdayjobs.com/en-US/External/job/Remote/Associate-Director—State-Government-Affairs—Advocacy_R319?mode=job&iis=Job+Board+-+Indeed&iisn=Indeed.com

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• LOCATION: REMOTE NJ, DC OR MD

The Associate Director, State Government Affairs & Advocacy, Mid Atlantic Region will be responsible for interfacing with  patient advocacy groups, professional associations, government officials, and coalitions to align healthcare policy, advocacy, and legislative priorities at the state level. Other responsibilities include;

• Develop strategies and coordinate initiatives with alliances that promote access to therapies, preserve patient/provider choice, and eliminate barriers to treatment.
• Help shape and influence healthcare policies and provide feedback to OAPI regarding emerging regulatory/legislative issues that impact OAPI business.
• Interact with state policy decision-makers and influencers, advocacy leaders, governor’s office policy staff, relevant state legislative committee chairs, members, and support staff and Medicaid policy officials regarding issues impacting access to the continuum of care within the health care delivery system, in accordance with OAPI strategic objectives.
• Develop working partnerships to support OAPI goals (i.e. consumer advocacy groups, professional associations, provider/medical organizations, government agencies, government officials, community leaders)
• Identify key influencer stakeholders and work within a team environment to develop strategies to effectively support OAPI policy positions.
• Conduct all activities in compliance with all applicable local, state, and federal laws and regulations and company policies.
• Position OAPI policy platform and corporate commitment; liaising between State MH authority, Medicaid Directors, and Patient Advocacy organizations.
• Monitor federal, state, and local payer systems and regulatory/legislative trends that potentially impact access to treatment and OAPI initiatives.
• Gain insight regarding risks, issues, and opportunities through alliance development, translating into value-added propositions.
• Represent OAPI in state PhRMA task force activities within assigned states.
• Manage relationships and activities with local lobbying counsel in support of OAPI’s crisis issues and/or opportunities.
• Communicate potential access risks to internal OAPI team with a sense of urgency, embracing a “no surprises” philosophy.
• Collaborate cross-functionally across OAPI departments to ensure favorable access/non-disadvantaged positioning.
• Develop and implement state/regional advocacy plans on an annual basis.
• Participate and drive in Matrix Team meetings.
• Execute appropriate marketing/policy initiatives with stakeholders through discussions, formal presentations, workshops, and programs as directed.
• Implement patient and caregiver education and outreach programs via advocacy and professional organizations as directed.
• Represent OAPI at state/local conferences, symposia, and events, with the goal of becoming a recognized partner within the stakeholder community.

Qualifications Required:  

• Bachelor’s degree, Master’s degree preferred
• Demonstrated knowledge in federal, state, and local healthcare  delivery systems, payer reimbursement, and policies impacting access to appropriate treatment.
• Establish a network of key patient advocacy groups, professional associations, and coalitions.
• Working knowledge of state policy and legislative environment; preferred executive-level lobby and regulatory experience.
• Neuroscience and Nephrology disease state knowledge is preferred.
• Proven track record in aligning and mobilizing advocacy organizations to shape the healthcare environment and advance initiatives.
• Established high-level relationships with a network of key thought leaders and influencers.
• 3-5 years within the pharmaceutical industry preferred; with direct reports and/or manager-level positions.
• Experience in working with Matrix Teams. Skills and Competencies
• Demonstrated networking, consensus building, and influencing skills.
• Strong communication and presentation skills, interacting with both external and internal audiences.
• Critical thinking skills, relationship management, conflict resolution, and the ability to work collaboratively.
• Demonstrated skills in leading and managing projects and the ability to work cross-functionally.
• Ability to effectively position messaging to multiple stakeholders, while working towards a common goal.
• Strong strategic planning ability, considering short-term and long-term implications of initiatives.
• Ability to quickly distill complex information from multiple sources into an easy-to-understand message.
• Self-starter, ability to proactively direct and manage cross-functional and cross-geographic teams.
• Ability to foster stakeholder cooperation; coordinate projects, manage community partnerships.
• Ability to be tenacious and resilient under pressure, while maintaining a strong sense of integrity.
• Scenario planning skills; recommend novel strategies to mitigate risk and capitalize on opportunities.  

Disclaimer:  This job description is intended to describe the general nature and level of the work being performed by the people assigned to this position. It is not intended to include every job duty and responsibility specific to the position. Otsuka reserves the right to amend and change responsibilities to meet business and organizational needs as necessary.Otsuka is an equal opportunity employer. All qualified applicants are encouraged to apply and will receive consideration for employment without regard to their protected veteran or disabled status, or any protected status.

Statement Regarding Job Recruiting Fraud Scams

Job postings, job offers, or introductions to enter into a business relationship with Otsuka through a third-party vendor may be unauthorized. Avoid being the subject of a scam by dealing only directly with Otsuka through its official Otsuka Career website https://vhr-otsuka.wd1.myworkdayjobs.com/en-US/External . Any authorized third-party vendor job boards should redirect any inquiry to this Otsuka Career website.

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• Otsuka Pharmaceutical Co., Ltd. is a global healthcare company with the corporate philosophy: “Otsuka–people creating new products for better health worldwide.” In the U.S., Otsuka is comprised of two companies, Otsuka America Pharmaceutical, Inc., and Otsuka Pharmaceutical Development & Commercialization, Inc., that share a deep commitment to the development and commercialization of innovative products in the spaces of neuroscience, nephrology, and digital medicine.

Driven by our purpose to defy limitation, so that others can too, we have an unwavering belief in doing more and transcending expectations. In going above and beyond—under any circumstances—for patients, families, providers, and for each other. It’s this deep-rooted dedication that drives us to uncover answers to complex, underserved medical needs, so that patients can push past the limitations of their disease and achieve more than they thought was possible each and every day.

OPDC and OAPI are indirect subsidiaries of Otsuka Pharmaceutical Company, Ltd., which is a subsidiary of Otsuka Holdings Co., Ltd. headquartered in Tokyo, Japan. The Otsuka group of companies employed 47,000 people worldwide and had consolidated sales of approximately USD 13 billion in 2019.

We invite you to explore our open positions for an opportunity to join our 1,700 colleagues in the U.S. whose passion for our mission and pride in our company have earned us certification as a Great Place to Work by the Great Place to Work Institute.

Clipped from: https://jobs.ssmhealth.com/job/11922803/government-affairs-director-madison-wi/

PRIMARY RESPONSIBILITIES

• Ensures organization is compliant with all aspects of the Medicare, Medicaid, and other applicable compliance program requirements defined by the Center for Medicare and Medicaid Services (CMS) and applicable state Medicaid agencies, both with respect to internal operations and vendor solutions. Serves as the primary point of contact for and lead facilitator of regular meetings with CMS Account Manager.
• Oversees accurate and timely data submission and reporting to regulators of government programs. Responsible for ensuring timely and accurate responses are provided to regulators and/or auditors in relation to general inquiries, corrective actions, and necessary deliverables.
• Manages the preparation and review of annual compliance training materials, company intranet articles and/or other training and education materials. Oversees continuous readiness activities, audit support and coordination activities, and remediation activities, related to all Medicare, Medicaid, and regulatory audits.
• Facilitates and supports the annual Compliance Program Effectiveness (CPE) audit and serves as business owner of relationship with external auditors selected to perform the audit.
• Provides operational areas with compliance support and guidance related to Medicare, Medicaid, and GPO requirements and facilitates organizational response to incidents of noncompliance. Performs the annual Compliance Program Effectiveness (CPE) Assessment and develops and implements annual compliance work plan.
• Establishes and maintains performance metrics and provides regular performance dashboards, report-outs of significant matters, and compliance updates.
• Ensures that processes are in place to identify new laws, regulations, sub-regulatory guidance, and contractual requirements applicable to government programs lines of business; distributes new requirements to staff and business partners responsible for or impacted by implementation, and monitors progress of implementation.
• Analyzes the regulatory environment and legal requirements applicable to Medicare, Medicaid, and other government regulated programs and identifies risk areas.
• Serves as government programs compliance subject matter expert in support of growth and expansion initiatives.
• Performs other duties as assigned.

EDUCATION

• Bachelor’s degree or equivalent combination of experience and education

EXPERIENCE

• Five years’ experience

PHYSICAL REQUIREMENTS

• Frequent lifting/carrying and pushing/pulling objects weighing 0-25 lbs.
• Frequent sitting, standing, walking, reaching and repetitive foot/leg and hand/arm movements.
• Frequent use of vision and depth perception for distances near (20 inches or less) and far (20 feet or more) and to identify and distinguish colors.
• Frequent use of hearing and speech to share information through oral communication. Ability to hear alarms, malfunctioning machinery, etc.
• Frequent keyboard use/data entry.
• Occasional bending, stooping, kneeling, squatting, twisting and gripping.
• Occasional lifting/carrying and pushing/pulling objects weighing 25-50 lbs.
• Rare climbing.

 

Position Purpose:

Oversee and direct all population health functions for the assigned business unit based on, and in support of the company’s strategic plan. 

• Lead complex projects including affordability analyses around medical and pharmacy expense, business analysis, documentation of business requirements, and defining current/future scope of work. 
• Create and manage clinical affordability projects with internal partners, including but not limited to pharmacy, other clinical and network affordability teams, and pilots. 
• Create innovative solutions and process enhancements to drive financial and quality success. 
• Lead Clinical Model development and process support for the program in all approved state regions to align with the Clinical Model and meet the requirements for the program by supporting reports , technology and core team. 
• Identify trends between Consumer Assessment of Healthcare Providers and Systems (CAHPS) and Member Engagement; create programs/pilots to improve engagement with strategic partners. 
• Establish the organizations focus and direction regarding models of care that incorporate needs of all lines of business, focusing on quality and operational efficiencies across the organization.
• Create and measure business and clinical outcomes with respect to the provision of clinical support for practice transformation and successful transition of practice to shared savings/risk contract.

Education/Experience: Medical Doctor or Master’s degree in Nursing, Therapy, Pharmacy, Public Health/Administration or related field. MBA preferred. 8+ years of clinical experience in the Healthcare industry. Broad understanding of HEDIS and how it is used to drive business growth and efficiencies. Ability to develop, execute and improve clinical programs across large or multiple business units. Ability to identify, create and tracking clinical program opportunities for population health management. Prior experience in an innovation field, long term project, or evidence of driving successful clinical practice innovative solutions.

Licenses/Certification: Unrestricted license as MD, DO, PA, PT, OT, ST, RpH or PN in applicable state(s).

For Carolina Complete Health plan: Individual responsible for providing oversight and leadership of all prevention/population health, care management and care coordination programs, including Local Care management plan, AMH model and care management delivered by Local Health Departments. Must reside in North Carolina; More than 5 years of demonstrated care management/population health experience in a large healthcare corporation serving Medicaid beneficiaries; NC licensed clinician (e.g. LCSW, RN, MD, DO). Must reside in North Carolina.

Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law.

Clipped from: https://jobs.centene.com/us/en/job/CENTUS1206312EXTERNALENUS/Vice-President-Population-Health?utm_source=indeed&src=JB-10067&utm_medium=phenom-feeds&src=JB-10067

 

Job Title

Description

Job Summary: Oversees network and analytics strategy and execution for Delta Dental’s government business, including delivery of Medicaid and Medicare population health strategies. Directs matrix-oriented delivery model that ensures enterprise is delivering government-specific solutions unique to federal and state regulations.

Primary Job Responsibilities

1. Directs the daily activities of the team responsible for government programs network management, clinical performance, social determinants of health (SDOH), and the application of data analytics in maintaining optimal results.

2. Develops, recommends, and implements short and long term action plans in order to ensure the achievement of business unit goals.

3. Serves as leader in the development and monitoring of Medicare and Medicaid networks.

4. Establishes analytics function within the government programs business unit that is integrated into decision-making.

5. Communicates with and advises executive management on the planning and activities of government business.

6. Create and maintains governance of operational issues pertaining to government programs.

7. Supports business development efforts and serves as primary point of contact for network issues with clients.

8. Interviews, hires, evaluates, manages, and develops staff in order to ensure accountability for the achievement of departmental and individual goals and objectives.

Perform other related assigned duties as necessary to complete the Primary Job Responsibilities as described above.

Location

Delta Dental MI-Farm Hills-DDFH

Requirements

Position requires a bachelor’s degree with an emphasis in business administration or a related field, seven years of experience in Medicaid, Medicare, insurance and / or clinical operations, and three years of leadership experience.

Position requires experience in provider contract network development, management, optimization and familiarity of various provider compensation models including fee-for-service, capitation, value-based reimbursement, risk sharing, etc.

Position also requires advanced knowledge of the managed care industry, strong verbal and written communication skills; strong interpersonal skills; and the ability to resolve complex problems using independent judgment.

All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability or veteran status.

Clipped from: https://recruiting.adp.com/srccar/public/RTI.home?c=1214201&d=TRI&rb=INDEED&r=5000670111306#/

 

Supplemental Information

Job #: MVA/KDC/1163


This position is located within the LA. Department of Health/MVA/Eligibility/East Baton Rouge Parish

Cost Center: 305-7208
Position #: 64903

This vacancy is being announced as a classified position and may be filled as a Probational or Promotional Appointment.

Working Job Title: Assistant Section Chief;

Civil Service Title: Medicaid Program Manager 3


The Eligibility Program Operations (EPO) section of Louisiana Medicaid is seeking a candidate to fill the key leadership role of Assistance Section Chief. Ideal candidates should have experience managing and empowering a team, be decisive, have great communication skills, be adaptable to changing circumstances and exhibit integrity.


One of the core responsibilities of the EPO section is administering the operational components of the eligibility determination process for Louisiana Medicaid. The Assistant Section Chief ensures duties and responsibilities of the section are carried out timely and appropriately in accordance with state and federal regulation. The incumbent is responsible for planning, organizing, implementing and directing operations of the Medicaid Eligibility Policy, Procedures, and Training Unit. The Assistant Section Chief also serves as interim Section Chief in their absence.


No Civil Service test score is required in order to be considered for this vacancy.


To apply for this vacancy, click on the “Apply” link above and complete an electronic application, which can be used for this vacancy as well as future job opportunities. Applicants are responsible for checking the status of their application to determine where they are in the recruitment process. Further status message information is located under the Information section of the Current Job Opportunities page.


*Resumes WILL NOT be accepted in lieu of completed education and experience sections on your application. Applications may be rejected if incomplete.* You must describe your actual duties as you will not be qualified based on job title alone.


A resume upload will NOT populate your information into your application.
Work experience left off your electronic application or only included in an attached resume is not eligible to receive credit


For further information about this vacancy contact:
Kelsi Chaney
LDH/Human Resources
P.O. Box 4818, Baton Rouge, LA 70821

Kelsi.Chaney@la.gov

Qualifications

MINIMUM QUALIFICATIONS:

A baccalaureate degree plus five years of professional experience in administrative services, economics, public health, public relations, statistical analysis, social services, or health services.

SUBSTITUTIONS:
Six years of full-time work experience in any field may be substituted for the required baccalaureate degree.


Candidates without a baccalaureate degree may combine work experience and college credit to substitute for the baccalaureate degree as follows:


A maximum of 120 semester hours may be combined with experience to substitute for the baccalaureate degree.


30 to 59 semester hours credit will substitute for one year of experience towards the baccalaureate degree.
60 to 89 semester hours credit will substitute for two years of experience towards the baccalaureate degree.
90 to 119 semester hours credit will substitute for three years of experience towards the baccalaureate degree.
120 or more semester hours credit will substitute for four years of experience towards the baccalaureate degree.


College credit earned without obtaining a baccalaureate degree may be substituted for a maximum of four years full-time work experience towards the baccalaureate degree. Candidates with 120 or more semester hours of credit, but without a degree, must also have at least two years of full-time work experience tosubstitute for the baccalaureate degree.

Graduate training with eighteen semester hours in one or any combination of the following fields will substitute for a maximum of one year of the required experience on the basis of thirty semester hours for one year of experience: public health; public relations; counseling; social work; psychology; rehabilitation services; economics; statistics; experimental/applied statistics; business, public, or health administration.

A master’s degree in the above fields will substitute for one year of the required experience.

A Juris Doctorate will substitute for one year of the required experience.

Graduate training with less than a Ph.D. will substitute for a maximum of one year of the required experience.

A Ph.D. in the above fields will substitute for two years of the required experience.

Advanced degrees will substitute for a maximum of two years of the required experience.

NOTE:
Any college hours or degree must be from a school accredited by one of the following regional accrediting bodies: the Middle States Commission on Higher Education; the New England Association of Schools and Colleges; the Higher Learning Commission; the Northwest Commission on Colleges and Universities; the Southern Association of Colleges and Schools; and the Western Association of Schools and Colleges.

Job Concepts

Function of Work:
To direct large and very complex Medicaid program(s).


Level of Work:
Administrator.


Supervision Received:
Administrative direction from a higher-level administrator/executive.


Supervision Exercised:
Supervision over lower-level positions in accordance with the Civil Service Allocation Criteria Memo.


Location of Work:
Department of Health and Hospitals.


Job Distinctions:
Differs from Medicaid Program Manager 2 by responsibility for directing large and highly complex Medicaid program(s) and supervision exercised.


Differs from Medicaid Program Manager 4 by the absence of serving as the Section Chief administrating all functions of large and complex Medicaid program(s) and supervision exercised.

Examples of Work

Administers comprehensive statewide Medicaid programs by formulating and implementing current and long-range plans, policies, procedures and regulations.


Monitors policies and procedures to ensure that policies and system requirements comply with the law and federal regulations.


Participates in overall agency budget planning, preparation, and grant administration.


Works closely with state, regional, and parish administrative staff in developing management procedures and operational plans to assure that all agency programs are implemented at the field operations level as intended by federal and state laws and regulations.


Coordinates with state level administrative and support staff to improve program development, identify staff training needs and provide management and support services required and needed by department staff.


Develops, monitors and administers various methodology reimbursement policies.

Clipped from: https://www.indeed.com/viewjob?jk=2498f1cd781ffdfb&tk=1eq2d59f0t5gk800&from=serp&vjs=3

 

Job Description
In this role, the VP, Medicaid CFO will support Aetna’s ability to achieve its financial and strategic goals by managing and driving business actions and financial goals across the segment and the enterprise. Partner with senior management teams within the segment to maintain financial and operational control of the business, develop insight and drive execution. Ensure effective support of financial closing, planning and forecasting processes. Such activities drive the quality and integrity of P&L/cost center owner level reporting, membership and/or expense forecasts, product reporting and balance sheet reporting.
Partner with senior management to drive results, analyze and support full P&L responsibility with current revenue of $13-14B. Demonstrates urgency and holds self and others accountable for achieving high standards of performance and service by partnering with other financial disciplines, e.g., actuarial, underwriting, to assure pricing, product and risk alignment with business unit financial performance targets.
RESPONSIBLE FOR MONTHLY OPS REVIEW WITH SR LEADERS
Identify emerging product/market trend vulnerabilities and opportunities through analysis and insight generation; develop and implement action plans for business growth.
Coordinate development and monitor implementation of major business unit action plans to seize competitive opportunities and/or respond to performance shortfalls/plan variances.
Coordinate with other financial disciplines/functions in support of business transactions, e.g., PIP arrangements, regulatory issues, analysis of legal entities, etc.
Identify, suggest, monitor, and track effective medical cost analysis through coordination with medical directors, network management, underwriting, etc.
Support the coordination and development of business unit financial plans and forecasting tools/processes. Provide financial analysis and recommendations in support of management’s evaluation of strategic and business initiatives.
BUDGETING AND FORECASTING
Drive the dissemination and collection of input/output data, critical assumption and management reporting requirements.
Lead development and implementation of business unit performance measures.
Develop processes and set infrastructure to measure, understand and monitor business unit results relative to action plans and milestones.
Enhance processes that drive accountability measurements throughout the organization.
Align resources with shared services to drive business unit focus. Provide project management support for critical action plans other initiatives that cut across business unit and/or Aetna.
Support business unit competitive intelligence analysis and benchmarking.
Monitor and evaluate risk and delegation arrangements; recommend appropriate financial protections.
Ensure appropriate financial controls are in place for shared services and business unit
Develop high performing financial unit that performs a function (e.g., medical cost analysis) and/or can assist in the financial and business issues support being provided to the business.
Provide coaching/mentoring and development to direct reports and ensures talent development best practices for full span of control.

Required Qualifications
20+ years of related financial management experience within a health insurance company
Strong knowledge of Medicaid
Supporting a large national P&L

Preferred Qualifications
Master’s degree

Education
Bachelor’s degree

Business Overview
At CVS Health, we are joined in a common purpose: helping people on their path to better health. We are working to transform health care through innovations that make quality care more accessible, easier to use, less expensive and patient-focused. Working together and organizing around the individual, we are pioneering a new approach to total health that puts people at the heart.

We strive to promote and sustain a culture of diversity, inclusion and belonging every day. CVS Health is an equal opportunity and affirmative action employer. We do not discriminate in recruiting, hiring or promotion based on race, ethnicity, sex/gender, sexual orientation, gender identity or expression, age, disability or protected veteran status or on any other basis or characteristic prohibited by applicable federal, state, or local law. We proudly support and encourage people with military experience (active, veterans, reservists and National Guard) as well as military spouses to apply for CVS Health job opportunities.

Clipped from: https://jobs.cvshealth.com/ShowJob/Id/1034705/VP,%20CFO,%20Medicaid?utm_campaign=&utm_source=Indeed&rx_campaign=indeed0&rx_group=106219&rx_job=1468649BR&rx_source=Indeed&rx_ts=20201221T094813Z&utm_medium=recruitics_organic&prefilters=none&CloudSearchLocation=none&CloudSearchValue=none

Clipped from: https://www.governmentjobs.com/careers/washington/jobs/2931459/medicaid-program-manager-maps2-mpoi

 

Position Summary:
The Virtual Health Program Manager, reporting to the Director of Virtual Health, will assist in executing the virtual health roadmap for delivering local, regional, statewide and national virtual health services that achieve Carle Health strategic objectives as well as needs of our members and patients. The manager is be responsible for all aspects of executing virtual health projects (to include education materials & training) and managing the portfolio of projects; managing regional clients and their satisfaction of Carle Health virtual health program services; participating in the evaluation of new technology; assisting with project prioritization; and managing virtual health program specialist(s). In collaboration with their Director, scale the program in order to meet the growing demands of the organization. Understands clinical workflows in inpatient, outpatient, post-acute, regional and home-based environments, as well as technology innovations. Supports change management efforts to transform virtual healthcare for members, patients and families. Represents virtual health strategy to internal and external stakeholders, translating how virtual health can improve clinical and cost outcomes and member/patient and clinician experience.

Qualifications:

EDUCATIONAL REQUIREMENTS
Bachelor’s Degree in Related Field. Master’s Degree preferred.


CERTIFICATION & LICENSURE REQUIREMENTS
None, clinical licensure preferred.


EXPERIENCE REQUIREMENTS
A minimum of two to three (2-3) years of virtual health professional experience working in health care or technology sectors. Experience in a clinical setting as a direct patient care provider preferred. Experience with project management and associated tools and processes as well as experience being independently accountable for successfully meeting performance, leadership and project goals is preferred.


OTHER REQUIREMENTS
Ability to partner with operational, clinical, regional outreach and payer teams to effectively and efficiently deliver virtual health solutions; Recruit, lead, coach, and inspire direct reports. Dynamic, versatile and capable of exploring new concepts and impactful innovations; customer focus servant leader and first class problem solver. Ability to lead projects from concepts to completion; Exceptional written and oral communication and relationship building skills.

Essential Functions:

• Assist in development and execution of the virtual health strategic road map and achievement of organizational goals/objectives.   
• Effectively manage virtual health projects through its overall life cycle.   
• Manages virtual health equipment and vendor performance.  Make recommendations for changes when indicated.  
• Adapt and redirect the road map to meet evolving consumer needs and expectations, market needs, and market demand. 
• Work with leaders and clinical teams to develop use cases for new technology and virtual health solutions. 
  Regularly reviews program performance and member/patient feedback to ensure clinical outcomes and patient/member satisfaction and are optimized. 
• Work with service lines and clinical departments to define clinical processes, policies and procedures for each use case. 
• Provides education and training support to clinicians, support staff and patients. 
• Effectively manage the program portfolio and key performance metrics of program success.  
• Evaluate relevant technology solutions, introduce vetted technologies, and implement these technologies elevating clinical outcomes and financial metrics.
• Develop strong business relationships with different stakeholders and be a change agent.  
• Remains well-versed in reimbursement policies of Medicare, Medicaid and private payors, as well as federal, state and local laws pertaining to Virtual Health. 

Clipped from: https://careers.peopleclick.com/careerscp/client_Carle/external/gateway/viewFromLink.html?jobPostId=17867&localeCode=en-us

 

Thank you for considering a career at Bon Secours Mercy Health!

DIRECTOR, VALUE BASED PROGRAMS | Work From Home/Remote

The position of Director, Value Based Programs will support the development and execution of BSMH value-based program strategy. The candidate will establish working relationships with managed care payers for assigned programs and efficiently balance demands of multiple accounts to ensuring timeliness, contract compliance and performance results. He or she will facilitate strategic growth discussions with payer and internal stakeholders to identify new payer partnerships, program opportunities and progression along the risk continuum. He or she will be the subject matter expert for program requirements, educating key stakeholders, providing guidance and recommendations during contract negotiations, identifying program issues / opportunities and evaluating program results.The director will be assigned a specific book of business to lead in all aspects.

Essential Functions

• Advise Senior Leaders on emerging trends and methodologies for managed care value-based programs, CMS models of payment and Medicaid programs
• Collaborates with analytical resources to quantify the impact of alternative proposals for new and renewing programs and program audits. Facilitating the reconsideration process as applicable.
• Collaborates with leadership teams in the planning, assessment, design and implementation phases for value-based programs.
• Deliver education and training on assigned value-based programs requirements and contractual terms to key stakeholders
• Develops, assesses, and makes recommendations on program participation, improvements and renewals.
• Facilitate oversight meetings with the Payer to monitor and discuss contract performance
• Consult with key stakeholders to ensure program aligns with operational and clinical capabilities. Providing guidance on contract and program interpretations and requirements.
• Manage ongoing relationship and performance of value-based contracts, including identifying opportunities for performance improvement, review of reporting, validation of adherence to contractual terms, and facilitate resolution of issues.
• Negotiate value-based program terms and contract language for acute, ambulatory and Clinical Integrated Network as assigned in conjunction with Finance and Managed Care as applicable ensuring terms are in alignment with BSMH contracting priorities and objectives.
• Support the development of managed care and governmental payer strategies and initiatives to adapt to ongoing healthcare payment reforms and evolving payment methodologies, including ACOs and value-based care initiatives
• Supports governance and management meetings to include facilitation, planning and coordinating and follow-up

REQUIRED:

– Bachelors Degree in Business, Healthcare Management, Accounting, Finance or Related Field.

– Minimum of five years’ healthcare management experience involving complex delivery systems and organizations

– Effective negotiation and communication skills, plus the ability to utilize and interpret financial models and internal analyses. Knowledge of Managed Care, Finance, alternative payment methodologies, claim billing (CPT, HCPCS, ICD-10, DRG, etc. Self-starter, and proven ability to work well in a matrixed environment. Demonstrated project management skills with a successful track record. Proficiency with MS Office applications and web-based technologies. Excellent interpersonal communication with the ability to influence at all levels of the organization. Demonstrated ability to handle highly sensitive and confidential information in compliance with Health Insurance Portability and Accountability Act (HIPAA), and company confidentiality policies and procedures.

PREFERRED:

– Graduate Degree in Business, Healthcare Management, Accounting, Finance or Related Field.

– Experience evaluating, developing and/or negotiating value-based contracts Strong relationship building and influencing skills. Willingness to travel approximately 25% for face to face meetings. Excellent time management and prioritization skills. Highly collaborative team approach to work. Strong problem-solving skills, including the ability to systematically analyze problems, draw relevant conclusions and devise appropriate courses of action

Bon Secours Mercy Healthis an equal opportunity employer.

We’ll also reward your hard work with:

• Comprehensive, affordable medical, dental and vision plans
• Prescription drug coverage
• Flexible spending accounts
• Life insurance w/AD&D
• An employer-matched 403(b) for those who qualify
• Paid time off
• Educational Assistance
• And much more

Scheduled Weekly Hours:

40

Work Shift:

Days

Department:

SS Revenue Management – Revenue Management

All applicants will receive consideration for employment without regard to race, color, national origin, religion, sex, sexual orientation, gender identity, age, genetic information, or protected veteran status, and will not be discriminated against on the basis of disability. If you’d like to view a copy of the affirmative action plan or policy statement for Mercy Health – Youngstown, Ohio or Bon Secours – Franklin, Virginia; Petersburg, Virginia; and Emporia, Virginia, which are Affirmative Action and Equal Opportunity Employers, please email recruitment@mercy.com. If you are an individual with a disability and would like to request a reasonable accommodation as part of the employment selection process, please contact The Talent Acquisition Team at recruitment@mercy.com.

Clipped from: https://careers.bsmhealth.org/job/-/-/28933/3092659952