"Alerted.org

Director of Managed Care & Population Health

Galveston, Texas, United States

New

Executive - Business Professional

UTMB Health

Requisition # 2507122

Summary:

The Director of Managed Care & Population Health works closely with the Vice President, Managed Care and Clinical Contracting Strategies of UTMB Health System to provide leadership and supervision of continuous quality improvement efforts in Managed Care business decisions, value-based care initiatives, population health advancement and management of Direct Payment Programs. Assists in providing strategic oversight of payer and reimbursement initiatives, and assures compliance with regulatory requirements, quality management profiling, budgeting and financial management.

Scope:

+ Institution-wide – Director, Managed Care & Population Health leverages analytics to understand and respond to all populations/stakeholders/customers under the Health System (staff, patients, etc.), Academic Enterprise (faculty, community providers, students, etc.) and Institutional Support (staff, payors, etc.). Must have the ability to run programs (i.e., value-based payor programs, provider onboarding solutions, population management, etc.) that will benefit all entities within UTMB.

+ Payer Specific – Director, Managed Care & Population Health works closely with UTMB’s clinic leadership, staff, providers, RCO and other stakeholders to successfully develop and implement payer reimbursement initiatives. Through targeted process improvement work, the Director positively influences a single entity at UTMB while reaching for system-wide goals.

+ Operating Unit – The departments of Managed Care, RCO, Care Management, Office of County Affairs and Accountable Care Operations will all benefit from the Director, Managed Care & Population Health. Analytical and strategic alignment between operating units will be the Director’s focus.

Responsibilities:

+ Assists the Vice President with operational decisions and the development and implementation of strategic long and short-term plans to assure fiscal growth, solvency and accountability.

+ Develops and administers specific tools and methods for management of goals, projects and tasks.

+ Coordinates the activities of the employees assigned to the project(s) consistent with departmental team goals and objectives.

+ Develops a system to improve the financial position of the department and provide optimum service/outcomes.

+ Responsible for the review process of data collection and studies involving payer initiative evaluation/improvement efforts.

+ Maintains knowledge of current and potential changes in healthcare delivery, including healthcare reform, as it relates to payer dynamics, value-based care and Direct Payment Programs.

+ Develops goals and defines proactive strategies regarding UTMB’s market position, leakage, steerage and other metrics affecting market success.

+ Works to maintain close communication with leadership, hospital administration and legal counsel for all affairs relating to Managed Care, Value-Based Care Programs, and Direct Payment Programs.

+ Will lead post-acute care payer initiatives.

+ Makes recommendations on staffing and equipment needs.

+ Mentors staff and objectively evaluates and documents performance, taking corrective action as appropriate. Sets professional development and annual operating goals for each staff member.

+ Assures the completion of employee performance evaluations according to established timelines.

+ Assists in the development and planning for payer initiatives, value-based programs, including contributing to the educational and professional growth of support staff.

+ Adheres to internal controls and reporting structure.

+ Performs other related duties as assigned and/or required.

Minimum Qualifications:

+ Bachelor’s degree in related field plus five (5) years of overall experience in Managed Care, and with Population Health processes and healthcare related Direct Payment Programs.

Preferred Qualifications:

+ Master’s degree in related field plus six (6) years overall related experience in Healthcare Administration, Population Health Management or Healthcare Delivery Reform.

+ Experience with Medical Staff credentialing processes, Care Management processes, Population Health processes and/or Change Management (i.e., Value Stream Analysis).

+ Lean Management Knowledge/Process Improvement.

+ Lean Six Sigma Green Belt Certified, or higher.

Equal Employment Opportunity

UTMB Health strives to provide equal opportunity employment without regard to race, color, religion, age, national origin, sex, gender, sexual orientation, gender identity/expression, genetic information, disability, veteran status, or any other basis protected by institutional policy or by federal, state or local laws unless such distinction is required by law. As a Federal Contractor, UTMB Health takes affirmative action to hire and advance protected veterans and individuals with disabilities.

Compensation