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Community Care Partnership of Maine is looking for a Contract Manager! As Contract Manager, you will oversee all administrative components of CCPM contracts – everything from execution to negotiation to renewals. You will have a constant pulse on active licenses and agreements, managing contract relationships and details. We are looking for a highly organized, effective communicator who is skilled in collaborating across platforms to ensure contract operations are compliant and mission-focused. Ready to make amazing things happen?

Apply today!

Kootenai Health is hiring a Director of Quality and Care Management for Kootenai Care Network!

Do you thrive on analyzing and managing clinical and non-clinical Quality initiatives and activities within a clinically integrated health network to achieve transformational and sustainable improvements in outcomes? If so, our Director of Quality and Care Management is the perfect fit for you!

As the Director of Quality and Care Management, your core responsibilities include:

• Leadership of clinically focused quality outcomes for value-based care programs including Medicare, Medicaid, other governmental, and Commercial health plans
• Leadership of highly engaged chronic care management division deploying assigned, embedded, and/or independent chronic care management across more than 700 providers, 8 hospitals, and 60,000 covered lives under value-based agreements
• Network dyad partner with physician and other provider leaders of committees including Quality, Primary Care Service Line, Pediatrics, OB/GYN, and Practice Leader Workgroups
• Accountable for the development of target setting and action plan adoption to achieve contracted metrics and measurement of program outcomes for network primary, specialty, and facility services
• Integrating quality outcome goals in KCN programming and outreach
• Providing leadership and support to KCN Medical Director and Chair, Quality/Health Information Technology Committee, and others supporting the work of Utilization Management and Care Management throughout the network of providers for the achievement of sustained quality
• Acting as a resource to the President of Kootenai Care Network for support of companywide quality initiatives

Learn more and apply today!

Kootenai Health in Coeur d'Alene, ID is seeking the next President of their Clinically Integrated Network - Kootenai Care Network (KCN). KCN has developed sophisticated population health capabilities to successfully manage risk and deliver greater value to the people they serve of Northern Idaho. Today KCN has over 700 providers and 8 hospitals with 60,000 covered lives.

Kootenai Health is consistently recognized as a Gallup Great Workplace, with Magnet Hospital designation since 2006 and is a member of the Mayo Clinic Care Network. Today, the health system has 4,000 employees, over $700 million net revenue and an "A" rating by S&P.

The ideal candidate will have prior experience with a clinically integrated network, or leading value-based care initiatives in an integrated delivery system, health plan or medical group. The President will oversee operations of the network, payer contracting, data analytics and care management infrastructure in evolving payments models that include global risk capitation.

Expressions of interest or questions should be submitted to Mark Andrew or call (949) 797-3528.

Education

Work Experience

Required - 8 years related work experience; 3 years of supervisory.

Preferred

• 10 years of related work experience;
• 5 years of supervisory experience;
• 3 years of experience leading value-based strategy for a clinically integrated network or health plan.

Knowledge Skills and Abilities (KSAs)

• Strong leadership and the ability to drive strategy & engagement.
• Analytical skills and logical thought processes to help develop practical solutions to problems.
• Ability to translate data into a cohesive story.
• Strong verbal and written communication skills to effectively flex the style and content to reach varied audiences.
• Proficiency in using computers, software, and web-based applications.
• Effective verbal and written communication skills and the ability to present information clearly and professionally.
• Strong interpersonal skills.

Job Duties

• Leads a team that spans from strategy and analysis through execution.
• Drives change, working across varied departments and organizations to ensure performance improvement and quality metrics are used to drive improvement in patient outcomes.
• Provides analysis and design of projects with a meaningful impact on quality and financial performance
• Analyzes complex clinical and financial data from multiple sources
• Provides recommendations to leaders to improve quality and utilization metrics related to medical action planning and risk optimization.
• Evaluates assigned business processes, challenges, and goals to make recommendations to ensure those goals are achieved and challenges are overcome.
• Coaches performance improvement team.
• Deciphers large amounts of information to uncover and understand the underlying cause and makes recommendations for improvement.
• Performs other related duties as assigned.

Apply Now or send your resume to [email protected]

The Executive Director, Network Engagement and Performance provides leadership, strategic direction, and operational execution to AdventHealth Population Health , the Clinically Integrated Network (CIN) for Central Florida Division (CFD) Population Health is defined as “A model that delivers high quality, people-centered care through highly efficient and effective processes at every venue of care throughout a highly aligned, meaningfully connected ecosystem throughout a patient’s lifetime.” This position is accountable for the strategy and operational delivery of established structures, protocols and processes that drive the performance of the network in our value-based arrangements defined as lowering total cost of care below contracted targets and exceeding quality and experience requirements. Drives performance in quality, utilization, and service delivery expectations which include connected, convenient and complete care. Accountable for creation of, deployment of and operational execution of protocols and systems including but not limited to analytics, care management, meaningful interoperability, communications, education, and CDI. Adheres to the AdventHealth Corporate Compliance Plans and to all rules and regulations of applicable local, state, and federal agencies and regulatory bodies. Actively participates in outstanding customer service and accepts responsibility for maintaining relationships that are equally respectful to all.

Apply Now!

Integrated Care Solutions (ICS) is a care management company who seeks to transform healthcare by providing patient’s navigating through the healthcare system a superior experience and the highest quality outcomes by providing exceptional care management and seamless coordination of care throughout the post-acute care and home and community-based care continuums within the lowest cost possible.

Responsibilities

• Conduct data analysis and generate reports to drive both internal and external initiatives.
• Interpret reporting to provide insights and actionable intelligence to internal and external consumers of data.
• Support the management and development of our care management software platform and related analytics/reporting.
• Draft engaging and concise PowerPoint presentations to provide data analysis and strategic recommendations to clients.
• Identify ways to improve and expand data use, reporting, and analytics to support internal and external initiatives.

• An undergraduate or graduate degree in business, economics, public health, public policy, statistics, mathematics, or other related field
• At least 2 years of relevant full-time work experience
• Familiarity with policy issues and reimbursement models for acute and post-acute care providers 

• Exceptional analytical, problem solving, and quantitative skills; Great attention to detail
• Experience with healthcare claims and/or medical record data analysis
• Excellent PowerPoint skills and ability to develop senior executive-level presentation materials
• Advanced Excel skills and comfort working with large datasets, financial modeling experience a plus
• Experience with SQL and Power BI, Tableau, or other business intelligence software
• High level of initiative, quick learning ability, creativity, and resourcefulness

Please submit resume to Colin Yee.

UT Health San Antonio is hiring a Manager of Population Health and Value Based Care to oversee the Quality Department’s care management services, including case managers and community health workers. The manager ensures patients receive the proper care and service from the case manager they are assigned to.  

Job Duties 

• Reviews case manager and community health worker files, case notes, outcomes, and logged progress to ensure patients are properly cared for and tracked. Reviews and audits case management services provided to patients to ensure standardized delivery of such services. Provides feedback and corrective action reports to staff.
• Helps to coordinate and oversee therapies, evaluations, and treatment objectives that are developed by the case manager in partnership with the patient’s clinician.
• Development and implementation of systems, in alignment with UT Health San Antonio’s policies and procedures and principles, to enhance clinic operational efficiency and delivery of services to patients. This includes identifying a decreasing unnecessary redundancy in clinical care management processes. Assists with overseeing daily workflow of the Quality staff in the clinic to ensure established clinic workflows are being followed.
• Provides ongoing staff training within a specific office regarding the technical and patient management dimensions of UT Health San Antonio’s management system, including effective integration of information, technology, and treatment.
• Provides senior management with reports and analysis of case management reports.
• May be involved with providing case management services directly to patients.
• Assists with the implementation of policies and procedures regarding medical case management and provides leadership for staff by modeling expectations and behaviors.
• Maintains compliance with federal and state regulations and contractual agreements.
• Coordinates and communicates medical service functions with other departmental functions.
• Assists staff with computer systems issues related to case management.
• Conducts telephonic review of cases with clinicians, hospitals, and other providers.
• Responsible for staff scheduling, employee evaluations and resolving staff conflicts. Assigns cases, maintaining appropriate staffing ratios. Responsible for hiring staff and checking credentials, license requirements, and certifications.
• Assures that documentation meets guidelines for timeliness and accuracy.
• Assures that case plan goals, permanency goals for patients, and other appropriate services are established and achieved in a timely manner.
• Oversees case managers as they develop plans for UT Health San Antonio and Regional Physicians Network patients. This includes, but is not limited to, setting schedules and routines, arranging resource, coordinating services, providing advocacy, evaluating treatments, intervening in crisis, and providing general support.
• Meets regularly with CVO/ACO CMO to provide updates on activities in Quality and Care Management, assists in communications, and assists as needed in organization and tracking of Population Health and Value Based Care activities.
• Network Development, Physician Recruiting and Retention as directed by CVO/ACO CMO.
• Performs other duties as assigned.  

Knowledge, Skills, and abilities 

1. Knowledge: Ability to demonstrate in-depth knowledge of concepts, practices and policies with the ability to use them in complex varied situations.
2. Leadership: Ability to direct and contribute to initiatives and processes while creating a collaborative and respectful team environment and improving workflows.
3. Managerial/Supervisory: Knowledge of business and management principles involved in planning, resource allocation, human resources modeling, leadership technique, production methods, and coordination of people and resources.
4. Organization: Demonstrated ability to organize and coordinate work within schedule constraints and handle emergent requirements in a timely manner.
5. Detail oriented with meticulous planning, organizational and negotiating skills.
6. Ability to lead, direct and contribute to initiatives and processes within the institution while creating a collaborative and respectful team environment and improving workflows.  

Education 

• Bachelor's degree in a work-related field/discipline from an accredited college or university is required
• RN/APN degree from an accredited university is required  

Experience 

• Five (5) years of progressively responsible and directly related work experience is required.  

Licenses and Certifications 

• Current RN Licensure as a Registered Nurse in the State of Texas and/or Compact State Licensure
• Current Certified Case Manager Certification

Apply Now!

• Identifying and developing strategies for payer partnerships as well as network expansion influenced by strategic contracting relationships
• Having responsibility for payer relationship management, contract terms and conditions supported by pricing strategy, analytics, and impact plans
• Directing payer contract negotiations with input from executive leadership of Kootenai Health and Kootenai Care Network in support of population health initiatives
• Working with internal and external analytical teams and actuaries to ensure support for contract negotiations, performance, population health financial modeling, report production, and database management.

• BS in Finance/Accounting, business, or healthcare-related field required. Master’s degree preferred
• 7 years relevant experience at an insurance company or healthcare environment required
• Experience in payer contract negotiation
• Excellent analytical skills and ability to manipulate large data sets from multiple systems
• Familiarity with current common coding practices including CPT4, ICD9CM, and DRGs as well as current Medicare reimbursement methodologies and quality initiatives
• Knowledge of pricing, healthcare finance, managed care, provider incentives, and risk contracting required
• Knowledge of quality and outcome measures aligned with health plan scoring and ratings, including STAR ratings
• Understanding of healthcare expense risk for populations, its components (unit price and frequency), and drivers

• A passionate, knowledgeable Kootenai Care Network Team.
• Expanding department with room for future career development and continuous learning opportunities.
• Magnet Status - Kootenai has maintained MagnetTM status since 2006. This designation is nursing's top honor, accepted nationally as the gold standard in nursing excellence!
• Level II Trauma Center- Kootenai Health has achieved a Level II Trauma designation, verified by the American College of Surgeons Committee on Trauma.
• Mayo Clinic Care Network- Kootenai Health is a member of the Mayo Clinic Care Network (MCCN). As part of the Mayo Clinic Care Network, Kootenai Health staff have access to Mayo Clinic’s knowledge and expertise.
• Gallup Great Workplace Award - This award recognizes companies for their extraordinary ability to build an engaged workplace culture.

• 100% employer-paid health insurance premiums for full-time employees. Part-time employees pay only a small portion a month for medical, dental, and vision coverage
• Access to tuition reimbursement
• 457 investment plan through Fidelity with a match of 3-6% based on years of service and a defined contribution account which puts 2% of annual income into a retirement account
• Employee child daycare - within walking distance
• On-site learning through the Organizational Development department and teaching modules
• Competitive salaries
• Robust and incentive-driven Wellness Plans
• Full-spectrum employee reward, recognition, and retention programs, including outstanding employee development, training, and educational opportunities
• And much more!

If you have questions, please contact Kelly Wolfinger.  We look forward to getting to know you better! 

Apply Now! 

• P&L responsibility for the North region of the United States
• Oversee the development of policies and procedures for operational processes to ensure optimization and compliance with established standards and regulations.
• Oversee the negotiation and administration of value based contracts to ensure a strong provider network.
• Influence and drive network provider performance
• Ensure IHPA clients access to quality of care and adherence to regulatory requirements.• Represent the organization in its relationships with all stakeholders, including health care providers, government agencies, trade associations, health plans, and similar groups.
• Develop a sound short-and long-range plan for the organization.
• Ensure the adequacy and soundness of the organization’s financial structure and review projections of working capital requirements.
• Promote enrollment growth by supporting marketing event planning and execution.
• Develop and manage network provider relationships.

Primary Responsibilities: 

• Establish and develop clinical leadership over population health functions; to include specific payer and plan leadership, practice coaching, care management, medical neighborhood, and other priority areas that may be determined necessary
• Provision of clinical plan oversight to all value-based contracts and serve as the President and Medical Director of the Medicare Accountable Care Organization and Comprehensive Primary Care Plus arrangement
• Collaborates with all team-based leaders from matrix relationships, including care management, pharmacy, behavioral health, social work, etc.
• Overall responsibility for IT enablement and analytics infrastructure to serve both Population Health functions and Clinical Care delivery across Community Care
• In collaboration with the Quality Alliance leadership (Cleveland Clinic’s clinically integrated network); directs the navigation, on-boarding, and outreach function for the network
• Directs the adaptation and testing of care model innovation in response to changing contract trends, analytics, and forecasting
• Creates an operating structure to interface with subspecialty partners for the development of the medical neighborhood; to include leakage, co-management, and other care model transitions-Ensure compliance with all regulatory agencies and bodies (e.g., The Joint Commission) 

Get More Details and Apply Now!

The Director of Education designs content and format for educational programs that meet the ongoing learning needs of accountable care organizations (ACOs) and other value-based care programs.  In addition to developing content for well-established events such as conferences, boot camps, and webinars, the director will develop new activities such as learning collaboratives. This position works closely with NAACOS staff and leadership in developing educational programs, and coordinates with NAACOS members to learn about and address their educational needs.  This position will also monitor the NAACOS listserv to obtain insight into member needs and to ensure that the listserv is generating valuable exchange among members.  This is a new position that will allow for the incumbent to grow by expanding the association’s educational portfolio to evolve with value-based care. 

Essential Functions 

• Serves as lead staff for NAACOS educational portfolio covering ACO operations primarily with some clinical topics
• Collaborating with NAACOS staff and leaders, annually develops program for 2 conferences/pre-conference workshops, 2 boot camps, and approximately 8 webinars on ACO operations
• Develops new educational activities to meet member needs such as intensive collaboratives on ongoing critical ACO issues and less formal virtual discussions among ACO peers on timely challenges
• Monitors NAACOS listserv to ensure that participants are engaged, and questions are answered satisfactorily
• Maintains NAACOS web-based library of ACO resources (NAACOOL)
• Develops new written and web-based resources in conjunction with collaboratives and webinars to highlight lessons learned and key take-aways 

Competency 

• Familiarity with accountable care organizations and other value-based care programs
• Experience with designing and running educational programs
• Collaborative, team player able to work effectively with ACO leaders as well as colleagues on staff
• Entrepreneurial spirit, proactive, self-starter, who not only enjoys creating new programs but also excels at running them
• Excellent writer able to digest complex content into actionable resources for ACO executives 

Work Environment  

• Full-time position. Salaried with generous benefit package including health/vision/dental insurance, PTO, 401k, short-term disability
• Typical 8-hour day Monday-Friday
• NAACOS maintains a virtual workplace with staff working from home offices across the country
• Some travel required to attend in-person educational events, approximately 4 times a year to the Baltimore/DC metro area for conferences and boot camps 

Required Education and Experience 

• Master’s degree required; health-related field such as MHA or MPH preferred
• 6–8 years of work experience in health care settings required; ACO experience preferred
• Knowledge of value-based care programs such as ACOs required
• Familiarity with membership associations desirable
• Experience managing volunteers such as boards of directors and advisory committees 

Email cover letter and resume to [email protected] 

CHESS Health Solutions is a rapidly growing physician-led company owned by Wake Forest Baptist Medical Center and Laboratory Corporation of America, empowering clinicians and health systems make the transition to value-based medicine through innovative, team-based solutions, implementing care models that address the needs of the sickest patients while aligning clinical goals and financial goals to create more effective care methods and pathway. The Director of Pharmacy Services will perform the duties of a Clinical Pharmacist Practitioner while working with the physicians and staff of various CHESS Value Partners, consisting of health systems, hospitals and physician networks, to provide pharmacology education, disease state education, direct patient care, and medication management to improve the health status of the patients served. High Point, North Carolina, a beautiful and affordable community in the Piedmont Triad features easy access to Charlotte, the Blue Ridge Mountains and Atlantic coast beaches, and vibrant arts and restaurant scenes. There is the potential to work remotely with regular travel to our HQ and clients.

Requirements
Experience with ACOs, value-based care and/or population health, healthcare data sets and reporting methodologies

Education

• Board of Pharmaceutical Specialties or Geriatric Certification, or American Society of Health-Systems Pharmacist accredited residency program + 2 years’ clinical experience OR
• PharmD degree + 3 years’ experience and have completed a Certificate Program OR
• BS degree + 5 years’ experience with two completed certificate programs

CHESS Health Solutions offers a very competitive compensation package including: base salary, incentive bonus, comprehensive benefits and paid relocation.

CONTACT: [email protected]

• Leads the team accountable for strategic provider partnerships, provider contracting, network development, provider solutions, network adequacy, CIN Board and committee management, and operations.
• Identifies, evaluates, and incorporates best practices and trends to enhance quality, reduce cost, improve network integrity and provider engagement in support of value-based contracts.
• Accountable for partnering with executive leaders on payor contracting and direct to employer business development.
• Leads the team accountable for operationalizing employer, commercial and government agreements.
• Accountable for partnering with legal, Information Technology, security, and compliance to ensure necessary legal agreements related to network operations are in place.
• Accountable for the staff who identify and engage strategic provider partners to optimize CIN network cost while providing quality.
• Directs, oversees, and evaluates the work of Centrus Health staff. Holds team accountable for achieving strategic plans and performance targets.
• Directs the teams that manage contracts and coordinate provider payments.
• Directs and oversees team to ensure contracts are executed and operationalized; and manages the performance of contracts.
• Accountable for the teams managing provider data for directories, rosters, web sites and portals across the organization.
• Oversees and establishes processes to identify and resolve the most complex issues and problems impacting the organization’s population health initiatives and activities for community providers.
• Supports development and continued professional growth to meet company and individual goals for long-term success. Demonstrates an expectation for continuous quality improvement utilizing processes that include consideration of all stakeholders.
• Able to navigate the IT environment on behalf of operational leaders to support technology for key businesses objectives that serve CIN and PHSO stakeholders.
• Builds and supports effective relationships with internal and external stakeholders and organizations. Develops partnerships, coordinates activities, reviews work, exchanges information, and resolves problems related to operational business needs.
• Responsible for recruitment, training, hiring, and development of employees including staff and leadership level personnel supporting the CIN and PHSO teams.
• Serve as an advocate of the Population Health Service Organization and assigned areas in various settings including operational and CIN governance committees, executive steering committees, conferences, vendor meetings, and other collaborators.
• Communicates the vision, translating it into actionable projects and activities. Maximizes staff’s contributions and assures timely decision-making reflecting the mission, vision, and values of the Centrus Health.
• Works with stakeholders to understand their strategic direction of Population Health and membership growth to proactively research and identify innovative solutions.
• Develops and oversees the department budget to meet goals and objectives. Meets annual budgetary goals. Translates organizational plans, goals, and initiatives into assumptions for annual operating and capital budgets. Manages and reports expenditures.
• Reviews, prepares, analyzes, and presents reports and recommendations to senior leadership regarding operations, program, services, and other applicable areas of interest to provide concise and accurate information that aids in decision-making.
• Participates as a subject-matter expert and may lead or facilitate task forces, teams and councils to plan, implement and coordinate programs, services and activities for the organization. May serve as a staff resource to the organization’s governing board and appropriate committees.

KNOWLEDGE AND SKILLS REQUIRED:

• Demonstrates the ability to develop and maintain ongoing relationships with Senior Executives.
• Able to assess and identify new opportunities associated with the support of services and processes.
• Ability to lead the activities of other leaders to meet deadlines and resolve problems.
• Expert level presentation, verbal, and written communication skills.
• Capable of solving problems timely, effectively, and accurately.
• Demonstrates the ability to engage and educate stakeholders on services related to population health operations.
• Solid emotional intelligence

KNOWLEDGE AND SKILLS PREFERRED

• Finance and Budget
• Understanding of health plan data compliance requirements
• Innovative and strategic thinker
• Consulting experience

EDUCATION AND EXPERIENCE REQUIRED

• Master’s Degree in the field of Business, Healthcare Administration, technology or other related field and seven years experience in healthcare, provider practice, health plan or technology
• Bachelor’s degree in business, Healthcare Administration, technology or other related field with 10 years of experience in healthcare, provider practice, health plan or technology
• Experience with Population Health solutions
• Experience leading multiple teams

EDUCATION AND EXPERIENCE PREFERRED

• Recognized expert in Population Health
• Recognized expert in solving business problems and understanding processes.

REQUIRED COMPETENCIES

• Building Customer Relationships - Ensuring that the customer's (internal or external) needs are met; building productive relationships with high-priority customers; taking accountability for customer satisfaction and loyalty; using appropriate interpersonal techniques to prevent and resolve escalated customer complaints and regain customer confidence.
• Building Networks - Taking action to establish and maintain connections with people outside one's formal work group, including those outside the organization (e.g., peers, cross-functional partners, and vendors) who are willing and able to provide the information, ideas, expertise, and/or influence needed to achieve work goals.
• Decision Making - Identifying and understanding issues, problems, and opportunities; comparing data from different sources to draw conclusions; using effective approaches for choosing a course of action or developing appropriate solutions; taking action that is consistent with available facts, constraints, and probable consequences.
• Driving Innovation - Creating an environment (culture) that inspires people to generate novel solutions with measurable value for existing and potential customers (internal or external); encouraging experimentation with new ways to solve work problems and seize opportunities that result in unique and differentiated solutions.
• Execution - Ensuring others contribute to organization strategies by focusing them on the most critical priorities, measuring progress, and ensuring accountability against those metrics.
• Strategic Planning - Obtaining information and identifying key issues and relationships relevant to achieving a long-range goal committing to a course of action to accomplish a long-range goal after developing alternatives based on logical assumptions, facts, available resources, constraints, and organizational values.
• Customer Focus - Ensuring that the internal and external customer’s perspective is a driving force behind strategic priorities, business decisions, organizational processes, and individual activities; crafting and implementing service practices that meet customer’s and Centrus Health’s needs; promoting and operationalizing customer service as a value.
• Business Acumen - Using one's knowledge of economic, financial, market, and industry trends to understand and improve individual, work group, and/or organizational results; using one's understanding of major business functions, industry trends, and own organization's position to contribute to effective business strategies and/or tactics.

Qualified Candidates please email resume to Jill Watson.

The Vice President, Partner Engagement is the market leader responsible for the successful delivery of services across a set of regions and clients with a focus on overall operations and P&L achievement. The Vice President, Partner Engagement functions as the regional account interface and drives the management of market strategy, product expansion, and growth opportunities, as well as Network/Provider relations. The position partners with both business and product development and focuses on delivering consistency in services. The Vice President, Partner Engagement works closely with Clinical Operations to drive quality performance and results. This critical role is ultimately accountable for creating and driving the market strategy to deliver operational, quality, and financial performance.

• Position holds ultimate responsibility and accountability for all operational outcomes, including all metrics that drive utilization and costs.
• Build relationships with client organization(s) and providing high quality services and effective account management throughout the client relationship.
• Provide leadership and direction through Clinical Operations leadership for all market-level care management staff to ensure maximum colleague engagement and productivity of the clinical team.
• Develop and execute key strategic initiatives within a market, including quality, cost and service metrics, and assisting clients with product and services expansion.
• Cultivate and maintain effective business relationships internally and with executive decision-makers within client organization(s).
• Develop strategic relationships with both Acute and Post-Acute (PAC) providers.
• Deliver successful financial performance, in collaboration with ICS Executive leadership, through management and development of operational metrics, budgets, and the clinical program delivery.

Please send letter & resume to [email protected]

Serves as the key finance leader responsible for overseeing the development, implementation and ongoing financial performance monitoring of new value based financial vehicles and/or programs (e.g., MSSP, CMS BPCI, commercial bundles). Serves as key finance liaison with the offices of strategy, clinical transformation, the quality alliance and the department of Market and Network Services in the deployment of financial vehicles such as alternative payment models, population health risk products and associated platforms.

Responsibilities:

• Leads and partners in the design, implementation and ongoing monitoring of value based financial vehicles, partnerships and programs.
• Leads the effort to explore and pilot innovative financial vehicles to capture value for CC.
• Engages with clinical leadership to understand clinical care innovation and value creation.
• Partners in efforts to develop the capabilities required for CC to successfully take on financial risk.
• Leads the development of an industry leading, highly innovative team recognized for thought-leadership, strong partnerships and leading edge practices.
• Partners in contract/network design and negotiation.
• Partners in setting cost and utilization targets.
• Monitors financial performance and identify cost and utilization opportunity.
• Develops processes to support Finance in a production mode to ensure program success and compliance.
• Serves as key liaison to external parties related to financial vehicle design, implementation and performance monitoring (e.g., CMS, commercial payer committees, State of Ohio).Actively researches financial and reimbursement innovation.
• Serves as key finance participant on relevant committees such as GoTo Market, Contracting, Population Health and Specialty Care.
• Works to advance Finance objectives on behalf of the Cleveland Clinic Health System.
• Interfaces with all levels of management, both internal and external to the Cleveland Clinic Health System.

Apply Now!

As a member of the Payer Operations team, the Manager, Medicare Operations will be a key team member that has deep experience with Medicare programs. The Manager will support, guide and coordinate operational processes associated with governmental programs including traditional Medicare and direct contracting programs Specific Responsibilities:

• Serves as the subject matter expert for new and existing traditional Medicare and CMS Direct Contracting requirements, and ensures that appropriate operational plans are put in place to meet those requirements
• Creates, updates and maintains standard operating procedures and reports to support Medicare work
• Responsible for overseeing ongoing operational duties (rosters, alignment forms, etc.)
• Identifies opportunities for process improvement and proposes efficient remedies
• Works cross functionally to ensure key stakeholders are informed and consulted with relative information
• Maintain professional and productive relationships with key internal and external stakeholders The successful candidate will:
• Be an effective project manager with the ability to plan, organize and execute plans with rigor• Have deep knowledge with Medicare ACO/MSSP programs plans including Direct Contracting• Be empathetic and an excellent listener; able to engage with internal and external stakeholders in a collaborative and positive manner.
• Uncomfortable with the status quo; a creative thinker and excellent problem solver and comfortable working independently
• A clear communicator who is able to synthesize and tailor communication to different audiences both verbally and in writing• Detailed-oriented; demand and deliver high quality work products
• Comfortable with a high degree of ambiguity, rapid change; an experimenter by nature

Apply Now

or reach out to Valerie Russell

Kootenai Health, located in Coeur d’Alene, ID, is hiring a Manager of Population Health Modeling and Analytics! In your role as the Manager of Population Health Modeling and Analytics, you will be responsible for managing financial, clinical and population health analytics for the clinically integrated network and facilitating the delivery of routine and ad hoc reporting utilizing knowledge of information systems, healthcare data, and decision support applications. You will serve as a trusted thought partner for leadership, collaboratively lead the development and execution of value-based analytics in support of contracting and performance management, leads projects in a matrixed environment while partnering with clinical, technical, network, and other stakeholders, and be responsible as the administrative lead or support for various committees. In your role as the Manager of Population Health Modeling and Analytics at Kootenai Health, you will have the opportunity to take pride in being a part of a healthy, growing, and high-functioning Magnet organization as you work to enrich the lives of those around you.

Apply Now!

Leads government program operations and performance for Baylor Scott & White Health's Accountable Care Organization including but not limited to MSSP, Medicare Advantage, Exchange, and BPCI-A. Responsible for understanding value-based programs and policy changes. Will work collaboratively with system departments such as legal, compliance, marketing, analytics, government affairs, quality and care management. Will also work directly with the system health plan and medical group on operations and value-based care performance opportunities.

Apply Now!

Serves in leadership role in the transformation of clinical care and clinical process improvement with physician members of the ACO and is liaison with the Information Technology department and payers regarding reporting and analytic needs. This position is responsible for ensuring reliable and actionable data is provided to physician practices for delivery of quality patient care. Responsibilities include writing and monitoring of policies and procedures to create and maintain clinically integrated networks, choosing quality metrics and developing strategies to meet metrics while improving health of the population. Responsible for providing leadership and representation on analytic requirements for various stakeholders to improve provider coordination and decrease population care gaps.*Bachelor’s Degree in formal four-year program in Informatics, IS, Computer Science or Nursing*Five years of related experience in informatics or care coordination*Process Improvement certification preferred. Use keyword ACO to locate the position and 

Apply Now!

Understanding of population health analytics, and claims based data systems and measures. Uses ACO’s claim data warehouse, and reporting systems to provide clinical and claims related reporting and analytics.· Provide support data integrity that drives operations, financial and quality queries.· Develops trend analysis reports to monitor performance indicators to compare with internal and external benchmarks; uses this data to assist leadership in decision-making, planning and implementing performance improvement strategies.· Works with team to identify research, gather and analyze data from multiple sources to compare, contrast and create information.· Maintains dashboards on quality, financial information outcomes, population health management (PHM) measures, and other metrics.· Tracks and analyzes financial models, shared savings program methodologies, strategic deliverables and operational milestones of project

Ideal Candidate:

• 3 years of experience in data analysis or related area
• 2 years of experience performing Data Analytics in a healthcare environment· Advanced knowledge and use of both SAS and SQL.
• Knowledge of Population Health Management.

Required Education:· Bachelor's degree in business administration, finance, healthcare administration or related field.

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GatorCare has retained WittKieffer to assist in the recruitment of a Medical Director.  This is a unique physician leadership opportunity at a direct service organization, formed in 2013, that serves the nearly 21,000 employees and their dependents of the University of Florida and University of Florida Health and Affiliates. GatorCare currently has 45,000 plan members across the enterprise. UF Health’s 2019 operating revenues exceeded $3.7 billion with 105,000 inpatient admissions, 336,000 emergency room visits, 78,000 surgical procedures (inpatient and outpatient combined), and 1,527,000 outpatient visits. Reporting to the president of GatorCare Health Management Corporation, the Medical Director will serve as an essential liaison and promote strong communications among plan staff, providers, vendors, and plan members. The new leader will provide clinical oversight for resource utilization, quality, pharmacy, operational effectiveness, and regulatory compliance. The ideal candidate will be a visible and engaging Board-certified physician, M.D., or D.O., with a strong clinical background and a current Florida license or the ability to obtain one. Prior commercial health plan experience overseeing medical management functions is ideal.
Please direct all nominations, applications of interest, and CVs and resumes by email to [email protected] or via phone at 917-209-033.

The Director of Population Health Services is a highly visible and the day-to-day operator for facilitating and implementing Kidney healthcare reform efforts with providers. The Director oversees effective implementation and the daily operations of the organization’s population health model in support of the Kidney Care First (KCF) and Comprehensive Kidney Care Contracting (CKCC) Graduated, Professional, and Global Models– in which dialysis facilities, nephrologists, and other health care providers manage care for ESRD beneficiaries and beneficiaries with chronic kidney disease (CKD) stages 4 and 5. This position is responsible for successful implementation, execution and evolution of Healthmap’s provider facing programs. The Director oversees and promotes data-driven approaches to improving cost, utilization, and quality of care.

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Vice President of Clinical Operations

Due to our continued growth, CHESS Health Solutions is seeking a Vice President of Clinical Operations (VPCO) to join our team. We are a rapidly growing physician-led company owned by Wake Forest Baptist Medical Center, and Laboratory Corporation of America, empowering clinicians and health systems to make the transition to value-based medicine. Reporting directly to our Chief Medical Officer, the VPCO is accountable for performance, vision and strategy for our care management and pharmacy services teams as they assist our provider systems in maintaining high performance in CHESS value-based contracts. The VPCO will advise clinical team directors on the development of EBM, care plans, polices, practices, and systems to monitor and implement quality control standards and measurements while ensuring compliance with regulatory agencies’ standards and requirements. This position is based at our headquarters in High Point, North Carolina, a beautiful and affordable community located in the state’s Piedmont Triad region featuring vibrant arts and restaurant scenes, a wide variety of outdoor recreation opportunities and easy access to Charlotte, Winston-Salem, the Blue Ridge Mountains and Atlantic coast beaches.

The ideal candidate for this role will possess the following qualifications:

• Experience with accountable care organizations, value-based care and/or population health
• Previous experience as a medical director or equivalent clinical position preferred
• Clinical degree from an accredited university required: MD, DO, NP, PACHESS

Health Solutions offers a very competitive compensation package including: base salary, incentive bonus, comprehensive benefits and paid relocation.

CONTACT: Michael Ginsberg - Executive Talent Consultant 

DCE Director of Operations

Position responsible for operational and financial performance for two DCEs, including the following key areas:

• Achieve profit and loss goals through delivery system transformation-establish local system of care
• Prioritize health care transformation topics to fit local conditions
• Create lasting engagement with Participant and Preferred providers which enables them to use data effectively to coordinate care and reduce inappropriate care
• Leverage relationships to anticipate expansion into new risk-based businesses.

The DCE Director is expected to seek and provide best practices from/to peer group. Each DCE may pilot innovative care models, tools and/or technologies to achieve effective and efficient care. Role requires demonstrated excellence in creating buy-in and engagement with Participant Providers and Preferred Providers and their support staff, and with community constituents. The DCE Director will work closely with value-based care departments such as Care Coordination, Patient Engagement, Quality, Risk Adjustment and with the Operations Team and Compliance Team.

Required: Bachelor's Degree in Health Care Administration, Business Administration, Marketing, Health Service 

Preferred: Master's Degree in a related field Required - 5+ years of experience in managing strategy, implementation and optimization of healthcare practice operations

OR

Required: 5+ years of experience in managing provider-facing (e.g., physician, hospital, etc.) communications, provider relations

OR

Preferred: 5+ years of experience with health plan and/or medical practice with Medicare Advantage or with CMS program such as ACO

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Senior Associate

Coker Group is a national healthcare advisory firm seeking additional expertise to join our Finance, Operations, and Strategy team. If you're ready to apply your learned analytical skillset and healthcare knowledge to daily work, while continuing to build this foundation and also begin to drive projects forward, the Senior Associate role is a great launch point. The Senior Associate will be primarily responsible for performing the detailed work on client engagements, functioning, and thinking like a “strategist” based on the direction from the Manager and Vice President/Senior Vice President on projects. The Senior Associate’s role on projects will be focusing on client interaction, helping establish the direction of the project, and having the deliverable prepared with minimal review and edits needed. The Senior Associate is expected to have foundational knowledge with some expertise in the subject matters at hand and be able to instruct Associates, where necessary. The Senior Associate should know what questions to ask, where potential problem areas exist and what is needed to move a project forward. Further, the expectation is that the deliverable coming from the Senior Associate is near-final form. The Senior Associate should be able to articulate fully all facets of the deliverable and the rationale for the work performed/decisions made in the deliverable. Generally, the mindset of the Senior Associate is expected to be one of “making it better”; taking ownership of their work, development of their subject matter expertise, and looking for ways/areas to make additional contributions to the success of Coker.
Ideal candidates will have a Bachelor’s Degree from an accredited college/university and 2 to 4 years of relevant industry experience in public accounting or healthcare consulting. Master's degree and/or additional certifications (ASA, ABV, CVA, CFA, CPA, MHA, MPH, PMP, etc.) are preferred. Please forward cover letter and resume to [email protected].

Director of Clinical Research

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Director of Partnerships

We’re looking for a talented and passionate business development professional who will help fuel our rapid growth as the leader in integrated behavioral health technology. Your focus will be on expanding footprint and capabilities in the market through strategic partnerships to support our business goals. You will work directly with our executive team to define short- and long-term strategies and then collaborate with internal and external stakeholders to achieve these goals.

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DIRECTOR OF PHARMACY SERVICES

CHESS Health Solutions is seeking a Director of Pharmacy Services. We are a rapidly growing physician-led company owned by Wake Forest Baptist Medical Center, and Laboratory Corporation of America, empowering clinicians and health systems to make the transition to value-based medicine. Together, CHESS and its value partners transform care through innovative, team-based solutions, implementing care models that address the needs of the sickest patients while aligning clinical goals and financial goals to create more effective care methods and pathways to improve patient outcomes. The Director of Pharmacy Services will perform the duties of a Clinical Pharmacist Practitioner while working with the physicians and staff of various CHESS Value Partners, consisting of health systems, hospitals and physician networks, to provide pharmacology education, disease state education, direct patient care, and medication management to improve the health status of the patients served. This position is based at our headquarters in High Point, North Carolina, a beautiful and affordable community located in the state’s Piedmont Triad region featuring all four seasons, easy access to Charlotte, the Blue Ridge Mountains and Atlantic coast beaches, and vibrant arts and restaurant scenes. There is the potential to work remotely with regular travel to our HQ and clients for the right candidate. CHESS Health Solutions offers a very competitive compensation package including: base salary, incentive bonus, comprehensive benefits and paid relocation.

Contact- Michael Ginsberg - Executive Talent Consultant, Wake Forest Baptist Health

CCM Client Success Manager - Texas Panhandle Clinical Partners ACO

The CCM Client Success Manager will champion the chronic care management (CCM) strategic approach to help improve the customer service focus in Care Coordination and Customer Service within the Texas Panhandle Region. The Manager will communicate and coordinate initiatives including overall management plans related to chronic care management, remote patient monitoring (RPM) and other value-add initiatives to deliver and ensure outstanding customer service to internal and external customers, maximize customer experience, and improve effectiveness and efficiencies. Focus will include updating metrics and deliverables in order to exceed expectations. Ensures that service targets, operational goals, implementations, communication and collaboration targets are met. The Manager is experienced in implementing innovative and results-focused customer service process improvement initiatives to drive overall CCM and RPM business performance. The Manager will represent TPCP ACO and its affiliates as a Customer Service Champion and will have accountability for partner and provider retention. Responsible for developing and implementing proactive initiatives to drive physician/partner engagement effectively and efficiently.

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ACO Project Manager

Prominence ACO Management Services supports 7 MSSP ACOs across the nation. We are seeking an ACO Project Manager to elevate value-based care initiatives across our ACOs: California Clinical Partners, Doc ACO, GW Health Network, Silver State ACO, South Texas Clinical Partners, Texoma Clinical Partners, and Texas Panhandle Clinical Partners The Accountable Care Organization (ACO) Project Manager is part of a centralized team providing project management leadership and coordination of ACO-oriented projects. The Project Manager is responsible for gathering and validating requirements, coordinating project tasks, regular communication to project stakeholders, identifying appropriate resources needed, and developing schedules to ensure timely completion of project. The position supports but is not limited to, complex development and implementation of significant initiatives within the organization in support of Senior Management. The Project Manager also provides expertise in project planning, execution, and monitoring. Oversees and manages the operational aspects of assigned projects and maintains a project management framework that enables a project core team to successfully execute projects. Maintains and analyzes project schedules and prepares regular status reports for management and key stakeholders. Tracks project risks, opportunities and issues in order to develop resolutions to meet quality and timeline goals and objectives.

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Director, Clinical Integration Quality

This role has direct oversight for quality performance in California’s Clinically Integrated Networks (CINs) and Accountable Care Organizations (ACOs), including the Dignity Health Care Network (statewide ACO) and serves as a key leader for Quality to ensure high performance on value based agreements. The Director will serve across multiple markets and will work in close partnership with the quality teams of Dignity Health Medical Foundation and Dignity Health MSO as well as Physician Enterprise and Population Health to implement the quality strategy to ensure alignment, efficiency and a positive experience for providers and patients. The Director leads and facilitates performance improvement efforts with a focus on independent providers, directs data analysis and reporting, monitors performance and looks ahead to mitigate risks. Working with leadership of Clinically Integrated Networks (CINs), Medical Groups and Division leadership, the Quality Director ensures clear definition of success measures, actively collaborates on financial analysis and is able to communicate about programs effectively to a variety of audiences and stakeholders. Reports to CIN leadership and collaborates closely with Payer Strategy and Relations (PSR) and clinical and quality leadership across the enterprise. Minimum Qualifications:-Deep expertise in Quality and Managed Care in California.-Experience designing and leading clinical quality improvement programs-Understanding of CMS and commercial value based programs and initiatives, including reporting requirements-Strong analytical acumen-Advanced Degree Preferred

Qualifications: RN license strongly preferred- Medicare ACO, CIN quality experience strongly preferred.- Experience in value based quality programs strongly preferred.- Experience in an outpatient/ambulatory/medical group environment preferred.- Ability to work in a matrix organization preferred.

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Market VP, Medical Operations

Arkansas Health Network (AHN), a physician-driven, Clinically Integrated Network (CIN) spanning across the state, announces the recruitment of a Market VP Medical Operations to serve as a key member of their management team to provide leadership in advancing Arkansas Health Network’s clinical programs. Responding to the transformation of health care, in 2014 CHI St. Vincent collaborated with integrated and community-based physicians to form AHN to more effectively manage the health of populations and improve the coordination of care through shared clinical information and common goals.
Responsibilities
With the guidance from the President and CEO of Arkansas Health Network and in partnership with the Network stakeholders, the Market VP Medical Operations will provide clinical leadership to support and advance population health strategies and clinical integration throughout Arkansas Health Network. The Market VP Medical Operations will develop, enhance, and manage clinical services and programs to further AHN’s population health management work with both governmental and commercial health plans. The position will serve as a medical liaison and implementer of physician-to-physician evidence-based guidelines to ensure appropriate resources are utilized for enhancing quality outcomes, cost containment, and appropriate utilization management.

Qualifications

• Licensure as a Doctor of Medicine (M.D.) or Doctor of Osteopathy (D.0.) from an accredited college/university
• Requires 10 years of clinical experience in respective specialty
• Requires 5 years of administrative experience in population health management/value-based care areas
• Demonstrated ability to oversee and positively impact clinical operations in a healthcare organization

To learn more, please contact Val Stayskal directly at [email protected] or 602-406-7928. View the position and apply today! 

Director of Operations

Florida Care Partners is a Florida statewide (CIN) that holds commercial and Medicare Advantage value-based health plan contracts and supports physician practices. Responsible for developing, implementing, executing the Clinical Integration program in collaboration with the VCP Executive Director, Medical Director, and Board of Managers. Administrative lead for the VCP Quality Committee, Joint Operating Committees with payer partners. Program champion for clinical leaders of practices participating in the VCP CIN & ACO.
Job #25086-11497

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Director of Value Based Care

The Director, Value‐Based Care leads and supports value‐based care initiatives across USRC. This position will work directly with USRC’s physician partners and USRC clinics around the country to implement & manage kidney focused, value‐based care initiatives. This work entails program implementation, work plan development, project management, and data‐driven performance improvement. In addition, this position will be support and lead the development of USRC’s value‐based care products, capabilities, and services. This product & capability development work includes managing USRC’s relationships with external strategic partners and managing internal projects related to USRC’s value‐based care product & capability offering. You can also email [email protected].

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HCS Clinical Director Population Management

Joining UNC Health Care system means you’ll become part of an inclusive organization with a mission to improve the health and well-being of the diverse communities we serve. Responsible for Population Management program development for UNC HCS Ambulatory Services.

Job Responsibilities:

1. Oversee day to day operations, policy development and regulatory compliance.
2. Responsible for full-scale project plans, financial oversight, quality audits and associated communications documents.
3. Participate in managed care contracting and other initiatives supporting the transition to value based care delivery and reimbursement.
4. Work collaboratively with multiple departments to develop effective data analytics, care management processes, cost avoidance measures and mutually beneficial relationships that enhance evidence based health care delivery and quality outcomes.
5. Implement performance metrics, including patient satisfaction, engagement, resource utilization and gap closure, and achieve or exceed contractual agreements.
6. Analyze health care trends, identify opportunities consistent with strategic goals and develop business plans to expand population management services and market share.
7. Communicate results to UNC HC Chief Value Officer, VP Population Health Services and Clinical Operations, VP of Quality Improvement and Innovation, Health Alliance Board of Directors and customers.
8. Actively participate in UNC HC committees related to high quality/low cost health care, internal and external provider relationships and managed care agreements.
9. Responsible for managing multiple projects simultaneously ensuring consistency with UNC HC strategy, commitments and goals.

Qualifications:

Education:

• B.S. degree in health related field required; MBA, MHA or MPH preferred.
• Licensure/Certification: RN or LCSW strongly preferred
• CCM preferred

Experience: Requires seven (7) years of related experience, with a minimum of five (5) years health care management experience; experience in project management, quality improvement processes, population management preferred.

Questions? Please connect with Executive Recruiter, Melanie Miller or Apply Now!

Director of ACO Operations

Do you have a passion for healthcare and helping others? Do you enjoy working in a fast-paced, patient-centered environment? Jump-start your career in our Quality department. Submit your application today! Our Quality teams are a committed, caring group of colleagues. We have a passion for creating positive patient interactions. If you are dedicated to caring for the well-being of others, this could be your next opportunity. We want your knowledge and expertise! We offer you an excellent total compensation package, including competitive salary, excellent benefit package and growth opportunities. We believe in our team and your ability to do excellent work with us. Your benefits include 401k, PTO medical, dental, flex spending, life, disability, tuition reimbursement, employee discount program, and employee stock purchase program. We would love to talk to you about this fantastic opportunity. Virginia Care Partners is an innovative, physician-led network collaborating to change the way healthcare is delivered in the Richmond and Tri-cities area! Network members include primary care and specialty physicians and the nationally recognized HCA Virginia facilities. Measureable quality care; patient, physician and staff satisfaction; and efficient, coordinated care with the patient at the center of care are goals of the network. Network physicians, who want to meet the demands of an industry that is moving from fee for service to fee for value, are committed to improving care delivery that enhances the health and lives of our patients.

• Collaborate with VCP Executive Director, Medical Director and Board to set CIN & ACO organization strategy and key initiatives. Collaborate with Board and Quality Committee chair to set clinical agendas and execute on determined action items.
• Responsible for leading the development, tracking, and implementation of the network’s quality, cost savings and outreach priorities.
• Lead the day-to-day operations of the clinical department staff to ensure compliance with VCP policy, HCA legal and CMS program requirements.
• Responsible for the education and training processes for CI program implementation with all participating physician practice sites.
• Leads evaluation of the CI program initiatives for effectiveness, and manages annual process to assess and improve the CI quality program.
• Identifies best practices in regards to the delivery of high quality, cost-efficient care in the hospital and physician practice settings.
• Collaborates with VCP Analytics to develop reports and conduct business analysis of CI program priorities. Analyzes and interprets clinical quality, cost, and utilization data, and sets or adjusts program strategy accordingly.

• Master’s degree preferred (health administration, business, nursing)EXPERIENCE:
• Experience leading population health/value based care efforts for a similar organization, including 5+ years in a management, leadership or consulting role. Accountable Care Organization (ACO), managed care, or physician group practice experience required.
• Progressive success leading clinical, administrative or finance-related functions within an ACO
• Experience with Medicare program management, health plan leadership or development, or provider contract management will be highly valued
• Professional experience with Patient-Centered Medical Homes, HEDIS measures, and with National Committee for Quality Assurance standards.

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