Gateway Health Plan
Job Description :
This job provides a range of operational and strategic assessments essential to the success of the Organization’s value based reimbursement and strategic provider initiative goals focused on improved member outcomes and financial return on investment. The incumbent provides analytical reporting and support to the processes that support value based reimbursement and strategic provider initiatives, conducts analyses and interprets system requirements, and uses project management techniques. Communicates effectively with management, project sponsors, and matrixed operational partners to ensure programs and initiatives are operating smoothly, meeting all deadlines and requirements and promotes a culture of performance excellence.
- Analyze metric-specific value-based reimbursement strategies, programs, and initiative results and processes to develop viable, business-driven and cost-effective solutions. Gather information, test, and probe complex assumptions on clinical and cost performance measurements. Collaborate as necessary with Advanced Analytics and Actuarial colleagues using appropriate project management tools and analytic techniques to promote continuous improvement.
- Assist in producing overall value-based reimbursement portfolio, program, metric, and provider deliverables using appropriate project management techniques. Define and manage small, less complex projects and objectives. Develop, maintain, and monitor routine issues and inquiries received relative to value-based reimbursement operations to ensure appropriate resolution.
- Serve as a resource to matrixed staff and stakeholders on current value-based program and strategic provider initiative operations.
- Assist in tracking, updating, and maintaining value-based reimbursement and strategic provider initiative program materials (e.g. manuals, reports, technical requirements, etc.) to ensure appropriate matrixed stakeholders/partners are aware of changes.
- Participate in problem solving resolution and decision making sessions for more complex issues and projects.
- Other duties as assigned.
- Bachelor’s Degree in Business Administration/Management, Economics, Engineering or Health Administration
- Master’s Degree in Life Sciences, Business Administration/Management, Economics, Engineering, Health Administration or Life Sciences
One of the following
- 3 – 5 years as a Business Analyst
- 3 – 5 years in Business Process Design
One of the following
- 3 – 5 years in Healthcare Reimbursement Models
- 3 – 5 years in Cross-Functional Project Coordination
- 3 -5 years in the Healthcare Industry
LICENSES OR CERTIFICATIONS
- General Computer Skills
- Written & Oral Presentation Skills
- Project Planning and Organization
- Collaborative Problem Solving
Languages (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
Lifting: 10 to 25 pounds
Lifting: 25 to 50 pounds
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 position 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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