Director Clinical Risk Adjustment Business Operations - Remote
Advocate Aurora Health
Oversee the teams responsible for the business processes and capabilities necessary for AAH to ensure accurate revenue in the portfolio of risk-adjusted lines of business. Primary focus will include Advocate Aurora Health/Advocate Aurora Advocate Medical Group (AAMG) and Advocate Physician Partners (APP) risk-based contracts. Will partner closely with the Director of CRA Clinical Operations and Medical Director for Clinical Risk Adjustment.
Major Responsibilities:
-Accountable for the financial processes related to all aspects of AAH’s risk adjustment business.
-Manages encounter data reconciliation oversight and various types of supplemental data file submissions.
-Partners with Managed Care/Business Development in the creation of new lines of business and payer relationships.
-Partners with the Director of Clinical Operations and the Medical Director to execute interventions designed to optimize AAH’s performance.
-Partners with relevant analyst teams to create metrics and dashboards that track performance and the effectiveness of interventions.
-Primary point of contact with Medicare Advantage payer partners for CRA-related topics, as well as primary point of contact with third party vendors.
-Understands the implications of bid rate both for capitated and non-capitated lines of business. Understands implications of CRA for AAH risk contract revenues and APP single incentive fund.
-Partners with Vice President of Clinical Risk Adjustment and Chief Compliance Officer to ensure programs adhere to relevant laws and regulations.
-Stays current with CMS and HHS risk model changes and industry best practices.
-Partners with medical group leadership and Clinically Integrated Network (CIN) leadership to design and manage incentives.
-Performs human resources responsibilities. -Develops and recommends operating and capital budgets and controls expenditures within approved budget objectives.
Link:
https://www.linkedin.com/jobs/view/3038591817
Senior Product Analyst, Product Strategy
Milliman MedInsight
We’re looking for a great addition to our Product Strategy team to lead innovation in provider analytics, focusing on products serving Value Based Care (VBC) provider success.
The purpose of this role is to increase the value our clients get from our data science products, addressing common client needs such as:
Identifying cost savings opportunities in VBC contracts
Measuring VBC contract performance
Patient stratification workflows to identify patients for condition management programs
Measuring and reporting on provider-level KPI metrics
By succeeding in this role, you will help MedInsight’s clients capitalize on the myriad of insights they already gain from our analytic methodologies.
This position will allow you to play a direct role in increasing adoption of MedInsight’s analytics and expertise.
You will have the opportunity to work with clients and generate a wide range of content to support analytics.
Preferred Skills and Experience:
At least 3-7 years of experience in healthcare, ideally with at-risk providers experience in areas such as: analytics, business intelligence, medical economics, finance, etc.
Skilled in data analysis. Adept at structuring data to tell stories, setting and testing hypotheses, designing reports, finding meaning in data and applying that meaning to specific business contexts.
Exceptional storytelling skills – excels at presenting data insights as powerful narratives that bridge the gap between the data and the decision makers who need to use it.
Skilled in information design, writing and editing, presenting, persuasive communication, statistics, scientific method, critical thinking, technical and non-technical communication, functional knowledge, and strategy
Initiative and intrinsic motivation for producing high quality work consistently.
Ability to work well on a multidisciplinary team.
Skilled in the use of Microsoft Excel, PowerPoint and SQL.
Link:
https://recruiting2.ultipro.com/MIL1017/JobBoard/f54234e9-dfde-b183-fd20-4fbdb19cba7a/OpportunityDetail?opportunityId=8357f67b-3b70-4c43-982d-be3a18c06500
AVP, Medical Reinsurance Broker
Gallagher Re
Junior broker/account manager for clients (health plans, provider organizations, stop loss carriers) that purchase reinsurance to protect from high cost medical claims. Work closely with c-suite. See link for more detail.
Link:
http://j.rfer.us/AJGDhWGVp
Reinsurance Analyst
Gallagher Re
Two year training program for new or recent college grads. Be immersed in front line client development activities which support senior brokers with new client relationship development and service support.
Link:
http://j.rfer.us/AJGNvgGVk
If You're Interested in Working at Validate Health...
Validate Health
If you're interested in working at Validate Health, just let me know. Happy to see how you could potentially be a fit in a collaborative environment.
Link:
www.validatehealth.com
Medicare Advantage Clinical Officer
Banner Health Insurance Division
Physician leader needed to oversee the clinical strategies and program design for Banner Health’s wholly owned DSNP (Banner MA Dual) and Medicare Advantage plans (Banner MA Prime and Plus).
Link:
https://practicewithus.bannerhealth.com/s/job-board?id=a3l3u0000011DBjAAM
Data Science Analyst II
Mount Sinai Health System
Mount Sinai Health Partners (MSHP), the population health division of the Mount Sinai Health System and the Icahn School of Medicine at Mount Sinai, located in the New York Metropolitan area and ranked 5th in Fast Company’s “Top 10 Most Innovative Companies in Big Data” is the team driving this transformation within Mount Sinai. The team includes 400+ employees with clinical, contracting, finance, IT, analytics, operations, and product development expertise.
Within MSHP, the Analytics (Clinical Informatics) team is a thoughtful and diverse group of data science analysts that have important functional roles throughout our business. Using analytical insights, we deploy our clinical programs to improve the health of attributed populations and maximize customer value. We work hand and hand with the larger clinical and operational team stakeholders and support their efforts. The team blends past experiences from health plans, health systems and public health roles with cutting edge data analytics and machine learning capabilities to deliver exceptional and unique value to our broader business. The frontier ahead includes exciting new tools and data science projects along with transformational business initiatives in a supportive environment and continuous learning culture.
The Data Science Analyst II collaborates with stakeholders from across the organization to develop sophisticated analytics to provide information, insights and BI (Business Intelligence) solutions that contribute to sound strategic planning, decision-making, goal setting, and effective performance measurement.
The Data Science Analyst II demonstrates sound and a more advanced understanding of the healthcare domain, technical data manipulation and analytic development skills and impact the patient community of the Mount Sinai Health System.
Link:
https://careers.mountsinai.org/jobs/2758586?lang=en-us
Business Intelligence Devloper
Redeemer Health
Want to work in a creative environment where data visualization supports business intelligence and informed decision making, using PowerBI, then this is the position for you. Desired at least 4 years of experience in developing dashboards. Health care and SQL experience a plus. Ability to work from home as well.
Link:
None
Clinical Quality Perf Improvement Coordinator - NEMG
Northeast Medical Group
Looking for a dynamic RN to join our team at Northeast Medical Group in CT!! Understanding of HEDIS, Stars and other quality measures used to evaluate ambulatory care is preferred. Experience with MSSP ACO and Value Based Care / Population Health is a plus!
Link:
https://jobs.ynhhs.org/jobs/51168?lang=en-us
Product Manager
Trella Health
We are looking for a Product Manager who is excited to build product for the next new module in our value-based care product. You’ll be on the ground floor of building new product, designing product strategy, creating great user experiences, and will face - and resolve - a huge variety of challenges. You’ll work with people across Trella Health: members of the Marketing, Sale, and Customer Success Teams in addition to engineers and designers.
As a member of the Product Management team at Trella, you will:
Work closely with teams across Trella Health to create a compelling vision for the product experience and to manage what is necessary to realize that vision. This includes identifying key opportunities, defining success criteria, driving alignment, managing roadmaps, removing obstacles, resolving issues, and shipping products.
Drive development of the features and capabilities for our value-based care product.
Link:
https://www.linkedin.com/jobs/view/3048107583/?refId=USYCvHdqid%2BRim%2BTqquC3w%3D%3D&trackingId=v2GKeXRhDbndCeqDA6LQ8g%3D%3D
ACO Executive Account Manager
Healthmonix
Onboarding and relationship management for ACO opportunities with our APP Impact software product.
Link:
https://healthmonix.com/wp-content/uploads/2022/03/Executive-Account-Manager-Job-Description.pdf
Director, Product Management
Trella Health
We are looking for a Director of Product Management to join our team to focus on coaching and developing our Product Management team while contributing to the overall product vision and strategy. This is an exciting opportunity to be the right hand of our Product leader as we scale our business and accelerate our growth. We are looking for someone who has strong Product Management experience and who has prior experience leading (coaching & developing) and supporting a team of Product Managers. Our Product Management team members are on the ground floor of building new product, designing product strategy, creating great user experiences, and will face - and resolve - a huge variety of challenges. Overall, you will join a highly collaborative team and will work with several team members across the Go-To-Marketing (Marketing, Sales, Customer Success) and Technology (Software Engineering & Data Science) teams. will serve in a high-impact role to help influence and scale the business.
Link:
https://www.linkedin.com/jobs/view/3048264373/?refId=USYCvHdqid%2BRim%2BTqquC3w%3D%3D&trackingId=plf2gkdinypgiNQ2pSRaGA%3D%3D
Director of Growth Marketing
Trella Health
The Director of Growth is responsible for leading the company's demand generation initiatives that build awareness and deliver pipeline across our product portfolio. This person will be responsible for achieving our inbound pipeline revenue targets. They will lead a team of specialists and agencies to support execution.
Link:
https://www.linkedin.com/jobs/search/?currentJobId=2987205368&f_C=5902262&geoId=92000000
Program Manager - Value-Based Performance
University Hospitals
Responsible for planning, coordinating, implementing value-based performance improvement strategies for UH Population Health (a population health service organization (PHSO) for UH Quality Care Network; a clinically integrated network (CIN) and UH Accountable Care initiatives (Medicare Shared Savings Program, Commercial and Medicaid). This individual will facilitate the coordination of value-based care to achieve strong financial and quality performance.
Link:
https://uhhospitals.taleo.net/careersection/2/jobdetail.ftl?job=220005M3&lang=en#.YmFXqQUdn8I.linkedin
Director of Business Development & Partnerships
Trella Health
We are looking for a Director of Business Development to join our team to help accelerate growth through developing and maintaining strategic partnerships with key organizations in the markets we serve. This is an exciting opportunity to have ownership of our partner program and provide innovative solutions that will impact future revenue streams and go-to-market strategies. By joining our team, you will work for a market leader and as a result will enhance your visibility in the healthcare industry by creating partnerships across all the markets we serve and throughout the opportunities for EHR integration partnerships. You will join a highly collaborative team and will serve in a high-impact role to help influence and scale the business.
Link:
https://www.linkedin.com/jobs/view/3008387879/?alternateChannel=search&refId=b2jXNLj8QqSj1crPAgZUCw%3D%3D&trackingId=dCzLjrDjEi9CfTc9Msmj%2FQ%3D%3D
VP, Customer Success
Trella Health
We are looking for a Vice President of Customer Success to join our team to drive the strategic direction and execution of Customer Success practices to ensure our customer experience allows customers to achieve their goals and drives Net Retention for Trella Health. You will be responsible for leading an awesome team of Customer Success Managers (CSMs) that deliver on the customer programs and practices that best support our range of Enterprise, Mid-Market and Small Business customers. You will partner closely with the other leaders within the department (e.g., integration, support, and services) to establish operating workflows that can scale as we grow. Additionally, you will have a pivotal role collaborating with our Go-to-Market leadership team and Enablement to communicate the voice of the customer to influence the product roadmap, sales, and marketing. Your people and customer first mentality will help create an environment that allows our culture to thrive within your team and across the company.
Link:
https://www.linkedin.com/jobs/view/3008386961/?alternateChannel=search&refId=b2jXNLj8QqSj1crPAgZUCw%3D%3D&trackingId=rGkNIUojE%2BscMVmthswHCg%3D%3D
Director, Valued Based Operations
Health Choice Network (HCN)
The Director of Value Based Operations is responsible for developing and maintaining meaningful payer and provider relations across HCN’s MSO and ACO networks. This role is accountable for developing strategic opportunities that translate into enhanced value-based care contracting opportunities.
Link:
https://workforcenow.adp.com/mascsr/default/mdf/recruitment/recruitment.html?cid=b3d54757-c241-42e9-9543-b455cbbb68ff&ccId=19000101_000001&jobId=383415&source=CC2&lang=en_US
Manager, Valued Based Operations
Health Choice Network (HCN)
For over 25 years, Health Choice Network (HCN) has been an employer of choice in South Florida, supporting health centers, patients, and the communities they serve. We are one of the first successful health center-controlled networks and our success is due largely to our Associates and their commitment to advancing our mission to improve the health status of our communities.
Do you want to join an organization that believes in empowering their most precious resource, their Associates? Are you innovative and results driven? HCN is looking for talented, qualified individuals to join our rapidly expanding, first-class team.
This position is responsible for managing and driving success with all network related projects and issues. Manage all technical aspects of network by planning, implementing and reviewing network infrastructure and services.
Link:
https://workforcenow.adp.com/mascsr/default/mdf/recruitment/recruitment.html?cid=b3d54757-c241-42e9-9543-b455cbbb68ff&ccId=19000101_000001&jobId=390727&source=CC2&lang=en_US
Director of Value Based Care
WellSpan Health
This position provides team-based direction for value-based care programs including development of new programs, management of program application and onboarding processes, oversight of program compliance and regulatory requirements, and ongoing development and deployment of performance maximization strategies. This position maintains niche expertise in commercial and/or governmental payment models to optimize WellSpan’s performance under value-based care programs, requiring strong partnership with clinical, operational, and administrative entities and WPN. Monitors changes in federal and state laws and regulations that impact programs designed by the Centers for Medicare and Medicaid Services (CMS), state Medicaid programs, and relationships with commercial payors and administrators.
Link:
https://pm.healthcaresource.com/cs/wellspan/#/job/19416
Healthcare Actuarial Specialist
Health Choice Network
Health Choice Network (HCN) has been an employer of choice in South Florida for the past 26 years. HCN is poised to attract top talent by offering a robust benefit package, providing health insurance coverage for individual and family and more. HCN offers competitive compensation, retirement plan, professional development to name a few. Our corporate office design is inspired by the Herman Miller Living Office concept work environment, providing a high-performing workplace that deliver an enhanced experience of work for our employees. With 52 safety-net organizations in nineteen states serving approximately 2.2 million patients, HCN is recognized as a leader in the integration of health information technology among health centers and safety net providers. HCN provides key business services, strategic initiatives and the latest in health information technology.
Position Summary:
This position is responsible for supporting the strategic financial objectives of HCN Value Based Services team and collaborate with payers to ensure the appropriate information is available to drive improved performance, decision-making and support business needs. This position assists the VBS Director in identifying, quantifying, and managing financial and related operational risks to any areas of assumed financial risk by the organization, including ACO, and managed care contracts.
Link:
https://workforcenow.adp.com/mascsr/default/mdf/recruitment/recruitment.html?cid=b3d54757-c241-42e9-9543-b455cbbb68ff&ccId=19000101_000001&jobId=383796&source=CC2&lang=en_US
Regional Director of Case Management Operations
WellSpan Health
Supervises and oversees the operations of the Case Management Department in the designated region of WellSpan Health. Works with hospital, regional, medical group, Population Health, post-acute services and system leadership to support the operational achievement of strategic goals. Helps to identify and works in a team leadership model to develop and maintain departmental operations that are consistent with Health System and Community requirements/needs. Provides leadership regarding future strategic goals and the integration of case management principles throughout the System.
CM Manager of Henry Ford Health - West Bloomfield
Henry Ford Health
GENERAL SUMMARY:
The Integrated Case Management Manager for Population Health is an interdependent member of the patient-centered care team or treatment team responsible for the collaborative practice of assessment, planning, facilitation, care coordination, evaluation and advocacy for options and services to meet an individual’ss and family’s comprehensive health care needs though communication and available resources to promote patient safety, quality of care and cost effective outcomes.
Addresses the needs of patients who have experienced a critical event or diagnosis that requires complex management strategies and the extensive use of resources to optimize health outcomes along the care continuum.
Provides services to patients from ambulatory, inpatient or health plan settings.
Link:
http://p.rfer.us/HENRYFORDdfwbTs
