Senior Director, Care Delivery Org – Value Based Care Contracting

🕒 il y a 5 jours

🇺🇸 États-Unis – Télétravail

💵 $149 882 - $224 823 / an

⏰ Temps Plein

🟠 Senior

👔 Directeur

👻 Score fantôme 0%

Ce que ça veut dire : la probabilité que cette offre reste ouverte sans recrutement actif.Comment le lire : 60 % ou plus, on pense que c'est une offre fantôme. Un score plus bas est moins inquiétant.Comment on la calcule : ancienneté, republications, postes ouverts vs taille de l'équipe, rapidité de clôture, et si le salaire est indiqué.À noter : une estimation à partir de données publiques, pas un jugement sur l'entreprise. De vraies offres peuvent avoir un score élevé, alors prenez-le comme un indice, pas comme un fait.

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Alignment Health

Site WebLinkedInTous les Emplois

501 - 1000 employés

Fondée en 2013

⚕️ Assurance santé

🛡️ Assurance

🏥 Santé

💰 €135 000 000 Series C en 2020-03

Healthcare Insurance • Insurance • Healthcare

Alignment Health se consacre à fournir des soins complets pour les membres de Medicare, en mettant l'accent sur les besoins des personnes âgées, des personnes atteintes de maladies chroniques et des personnes fragiles. Avec pour mission de transformer les soins de santé pour les seniors, Alignment Health utilise un modèle de soins personnalisé et une technologie avancée pour offrir des services de santé de haute qualité à faible coût. Leur équipe de soins de conciergerie disponible 24h/24 et 7j/7 collabore avec des prestataires locaux de confiance pour s'assurer que chaque membre reçoit des soins personnalisés, reflétant l'engagement de l'entreprise à traiter tous les membres comme des membres de la famille précieux.

Description

• Develop and execute value-based contracting strategy aligned with total cost and quality goals • Design alternative payment models and negotiate high-value contracts with IPAs, large physician groups, health systems, and other provider entities • Own the full contracting cycle from planning and document creation through negotiation, execution, and submission for loading • Lead negotiations for complex provider contracts and facilitate external provider meetings • Align negotiation strategy with network accessibility, quality, compliance, and financial performance goals • Develop value-based strategic plans and oversee contract performance with targeted provider groups • Evaluate and implement network strategic plans to achieve contracting targets and manage medical costs • Review medical claims data, analyze cost trends, and prepare executive summaries • Model risk-based contract scenarios and support business cases for contract structures and cost improvement initiatives • Build, lead, and manage the MSO Contracting team • Recruit, onboard, coach, manage performance, and retain contracting staff • Coordinate contract support with HEDIS, Credentialing, Grievance & Appeals, SIU, and Member Services • Lead complex, multi-stakeholder contracting projects from assessment through implementation • Ensure project milestones, stakeholder alignment, and deliverables are completed on schedule

🎯 Exigences

• Minimum 10 years of related experience in value-based contract negotiation within a managed care, Medicare Advantage, or healthcare services environment • Demonstrated track record negotiating value-based contracts with IPAs, large complex provider systems, hospitals, and large physician entities • Expert-level negotiating skills, including full-risk, shared savings, capitation, and alternative payment models • Experience reviewing medical claims data and developing executive summaries to mitigate medical cost trends • Proven ability to work in a matrixed organization and drive cross-functional alignment • Experience managing the complete contracting cycle from strategy and planning through execution and contract loading • Bachelor's degree in Healthcare Administration, Business, Finance, or a related field; equivalent combination of professional work experience and education will be considered • Demonstrated working knowledge of value-based care models, alternative payment methodologies, and Medicare Advantage contracting frameworks through applied experience • Advanced value-based contract negotiation skills • Advanced medical claims and financial data analysis skills • Advanced alternative payment model design and strategy knowledge • Advanced network strategy and provider relationship management skills • Advanced cross-functional influence and stakeholder alignment skills • Intermediate to advanced CMS Stars and HEDIS knowledge • Advanced project and program leadership skills

🏖️ Avantages

• Fully remote work • Equal Opportunity/Affirmative Action employment • Reasonable accommodations for individuals with disabilities