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Medicare Trend Insight Program Director

Location: Boise
Posted on: November 22, 2021

Job Description:

The position can be remote in our four Cambia states - OR, WA, ID or UT The Medicare Trend Insight Program Director partners with the Network Management (NM) team, Clinical Services team, Healthcare Informatics and other teams as needed to drive sustainable, high-value growth for Government Programs. This role is responsible for building trusting relationships Government Programs--- business partners by understanding each team---s vision, strategy and business objectives and establishing credibility as a trusted advisor and resource to influence positive outcomes. Minimum Requirements: Strong experience with Medicare quality, utilization, financial, Stars and Risk Adjustment activities and data, including the ability to educate internal teams and providers on the importance of these activities to the success of Regence and provider organizations. Demonstrated experience with Medicare case management and disease management models and programs, population health management, Quality, Stars and Risk Adjustment activities. Experience in evaluating and managing complex programs to ensure they achieve business objectives, including financial and health outcomes. Knowledge of health insurance industry trends, Medicare legislation, regulations and exposure to integrated finance and delivery models as they relate to population health management and improving Medicare member health outcomes and costs and driving growth Knowledge of provider billing practices, contracts and administration and the understanding of healthcare reimbursement methodologies. Strong communication and facilitation skills with all levels both within and outside the organization, including the ability to identify problems, develop solutions, and implement a chosen course of action to resolve complex issues and build consensus among groups of diverse stakeholders. Able to lead and motivate others by influencing and leading through ambiguity and the ability to thrive in an extremely fast-paced environment. Ability to coordinate initiatives and bring people together across multiple locations and functions while working across highly matrixed organizations. Strong problem-solving skills; demonstrated ability to think about business problems in new ways and the ability to clarify key issues in complex situations. Excellent written and verbal communication skills. Proficiency in using Microsoft Office tools and proven ability to display analytical data and research findings for effective presentations and improved decision making. Normally to be proficient in the competencies listed above The Medicare Trend Insight Program Director would have a bachelor---s degree (Master's preferred) in Business Administration, Healthcare Administration or related field and 5-10 years relevant experience in a large healthcare delivery, health insurance or health care consulting organization with specific experience building provider partnerships and/or accountable health agreements and/or Medicare experience or equivalent combination of education. This position includes 401(k), healthcare, paid time off, paid holidays, and more. For more information, please visit . We are an Equal Opportunity and Affirmative Action employer dedicated to workforce diversity and a drug and tobacco-free workplace. All qualified applicants will receive consideration for employment without regard to race, color, national origin, religion, age, sex, sexual orientation, gender identity, disability, protected veteran status or any other status protected by law. A drug screen and background check are required. Job Requirements:Responsibilities: Serve as the Medicare subject matter expert and the primary point of contact for internal and external partners with more complex Government Programs issues and questions, including quality, risk adjustment, and Stars. Develops strong working relationships with strategic providers to support value-based arrangements and/or products that produce mutual strategic benefit for the provider and Regence while promoting improved quality, cost and member experience. Develops and fosters collaborative, productive and professional partnerships with key internal stakeholders. Act as the liaison between NM and Clinical Services to ensure transparency, effective communication and alignment. Works with all levels of the NM organization to engage with, and drive, successful performance of Medicare provider engagement. Represent Medicare in cost stewardship efforts. Medicare subject matter expert regarding the Medicare provider landscape, network performance, and quality. Maintains general knowledge of value-based arrangements, including contract terms and performance targets. Represents the voice of Medicare in business decisions regarding provider contract negotiations for new value-based models and renewals.

Keywords: CAMBIA HEALTH SOLUTIONS, Boise , Medicare Trend Insight Program Director, Executive , Boise, Idaho

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