Gateway Health Plan
Job Description :
This job is responsible for all innovation and design related to the Organization’s advanced value-based programs, which encompass risk-based programs and custom reimbursement designs. The incumbent supports and drives the overarching strategy and operationalization of the health plan’s most advanced models. Manages a team and the ideation of new reimbursement methodologies and how they interlace into broader health plan and enterprise strategies and on-going initiatives.
- Perform management responsibilities including, but are not limited to: involved in hiring and termination decisions, coaching and development, rewards and recognition, performance management and staff productivity. Plan, organize, staff, direct and control the day-to-day operations of the department; develop and implement policies and programs as necessary; may have budgetary responsibility and authority.
- Work with actuarial and operations departments to develop and design value based programs across the continuum of care for the various Organization markets as well as reevaluate existing programs on annual or as needed basis
- Work with reimbursement, actuarial and analytic departments to ensure that operational capabilities are built in line with the strategic roadmap to ensure maximum flexibility and speed to market
- Assist on all current and future partnerships with Provider Partnerships, Operations, and other internal and external stakeholders as needed to bring programs from conception to deployment.
- Support the Enterprise on issues related to value-based reimbursement, including impact to organizational strategic efforts or new programs in development.
- Build and maintain collaborative relationships at all levels to ensure VBR vision aligns and integrates into the Enterprise’s strategic direction.
- Lead innovation workgroups with AHN, internal stakeholders, and external stakeholders to create new, innovative reimbursement designs to produce overall total cost of care savings. These work groups should also interlace business partners from Product, Network, and Clinical Services to create robust, all-encompassing strategies.
- Other duties as assigned
- Bachelor’s Degree in Health Administration, Business Administration/Management, Public Health, Healthcare Informatics or Pre-Medicine
- Master’s Degree in Business Administration/Management, Public Health, Health Administration or Healthcare Informatics
- 5 – 7 years in the Health Insurance Industry
- 1 – 3 years in Actuarial
- 1 – 3 years in Clinical Services
LICENSES AND CERTIFICATIONS
- Health Insurance
- CMS Regulations
- Healthcare Management
- Strategic Planning
- Public Health
Language (Other than English)
0% – 25%
PHYSICAL, MENTAL DEMANDS and WORKING CONDITIONS
Teaches / trains others regularly
Travel regularly from the office to various work sites or from site-to-site
Works primarily out-of-the office selling products/services (sales employees)
Physical work site required
Lifting: up to 10 pounds
Does Not Apply
Lifting: 10 to 25 pounds
Does Not Apply
Lifting: 25 to 50 pounds
Does Not Apply
Disclaimer: The job description has been designed to indicate the general nature and essential duties and responsibilities of work performed by employees within this job title. It may not contain a comprehensive inventory of all duties, responsibilities, and qualifications required of employees to do this job.
Compliance Requirement: This job adheres to the ethical and legal standards and behavioral expectations as set forth in the code of business conduct and company policies.
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