Director, Network Performance and Strategy – Preferred Experience in Managed Care

🕒 il y a 3 jours

🇺🇸 États-Unis – Télétravail

💵 $113 000 - $197 700 / an

⏰ Temps Plein

🔴 Expert

👔 Directeur

🦅 Parrain de Visa H1B

Cette entreprise a parrainé des visas H1B par le passé.

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CareSource

Site WebLinkedInTous les Emplois

1001 - 5000 employés

Fondée en 30+ years

🏥 Santé

🛡️ Assurance

⚕️ Assurance santé

Healthcare • Insurance • Healthcare Insurance

CareSource est une entreprise de services de santé axée sur la fourniture d'assurances santé abordables et de solutions de soins de santé. Elle propose une large gamme de plans incluant Medicaid, le Marketplace et Medicare Advantage, visant les adultes à faible revenu, les familles, les enfants, les femmes enceintes, les personnes âgées et les personnes handicapées. De plus, CareSource fournit à ses membres des ressources pour le soutien COVID-19, des avantages dentaires, visuels et auditifs, ainsi que des services de pharmacie. L'entreprise met l'accent sur l'accès facile à la gestion des soins de santé via des plateformes en ligne et une application mobile.

Description

• Provide strategic leadership for the enterprise Network Performance and Strategy function across markets and lines of business • Develop standardized frameworks for evaluating provider performance, network adequacy and access, utilization, affordability, leakage/OON utilization, quality, contracting performance, and other network measures • Translate network performance intelligence into strategies improving market performance, affordability, quality, network adequacy, growth, and competitive positioning • Advise network leadership using enterprise benchmarks, insights, and scalable solutions • Establish enterprise standards and methodologies for network performance management • Lead development of network performance reporting, analytics, decision-support tools, automation, AI, and proprietary platforms • Partner with Medical Economics and Actuarial leadership on network performance methodologies and analytical models • Partner with Value-Based Contracting leadership on provider segmentation, performance insights, and VBC strategy • Partner with Network Contracting on contracting priorities, provider targeting, reimbursement strategies, and network optimization • Identify and prioritize enterprise network opportunities and develop business cases • Oversee deployment of network performance capabilities across markets, including adoption, change management, and measurable business impact • Evaluate emerging technologies, data sources, vendors, and industry practices • Develop and manage the team's operating plan, talent strategy, priorities, and resource allocation • Represent Network Performance & Strategy with executive leadership and cross-functional stakeholders • Establish accountability for measurable outcomes and evaluate team impact on network performance and business objectives • Perform other job-related duties as requested

🎯 Exigences

• Bachelor's degree in healthcare administration, business, analytics, economics, public health, or related field required • Equivalent years of relevant work experience may be accepted in lieu of required education • Ten (10) years of progressive experience in managed care, healthcare strategy, network management, provider performance, medical economics, healthcare analytics, or related areas required • Five (5) years of experience in leadership roles required • Experience in Medicaid managed care and/or Medicare Advantage preferred • Experience with network optimization, provider performance, value-based care, reimbursement, or medical cost management preferred • Demonstrated understanding of health-plan network strategy, provider performance, healthcare economics, and managed-care operations • Skilled in using advanced analytics, AI, or technology-enabled operating models • Skilled in leading enterprise capabilities across a geographically dispersed health-plan organization • Familiarity with operating across multiple markets, business units, or lines of business • Strong executive communication, relationship management, and strategic problem-solving skills • Skilled in enterprise network strategy • Skilled in network performance management • Familiarity with healthcare economics • Executive leadership skills • Cross-functional influence skills • Skilled in developing and analyzing Market strategy • Knowledgeable in provider performance • Change management skills • Data-driven decision-making skills • Organizational leadership skills • No licensure or certification required • Up to 25% regular travel may be required

🏖️ Avantages

• Bonus tied to company and individual performance may be available • Substantial and comprehensive total rewards package • Total well-being support • Remote work arrangement

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