Director, Alternative Payment Model Performance

Job not on LinkedIn

🔥 21 hours ago

🇺🇸 United States – Remote

💵 $135.6k - $237.4k / year

⏰ Full Time

🔴 Lead

👔 Director

🦅 H1B Visa Sponsor

This company has sponsored H1B visas in the past.

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CareSource

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

Founded 30+ years

🏥 Healthcare

🛡️ Insurance

⚕️ Healthcare Insurance

Healthcare • Insurance • Healthcare Insurance

CareSource is a health services company focused on providing affordable health insurance and healthcare solutions. It offers a wide range of plans including Medicaid, Marketplace, and Medicare Advantage, targeting low-income adults, families, children, pregnant women, elderly adults, and people with disabilities. Additionally, CareSource provides members with resources for COVID-19 support, dental, vision, and hearing benefits, as well as pharmacy services. The company emphasizes easy access to healthcare management through online platforms and a mobile app.

📋 Description

• Oversee vendor contracts for medical and medical administrative services, shared savings arrangements, supplemental benefits, and quality reclassification administration costs • Collaborate with IT, Claims, and Operations teams to ensure contract operational components are administered correctly • Develop and manage policies and procedures for vendor contracts, including payments, reconciliation, invoicing, capitation payments, and shared savings arrangements • Lead financial strategy in vendor contract negotiations and ensure vendor payments meet MLR reporting and rate development requirements • Develop the Finance vendor contract strategic plan and Value Based Purchasing strategy • Establish performance metrics, ensure return on investment, and achieve financial and quality targets • Ensure Accounting has accurate information to load contract payments, including cost centers and vendor-cost classifications • Drive cost savings and efficiencies, including vendor consolidation and remediation • Maintain a database of contract provisions and results to analyze cost structures, variability, and best practices • Manage month-end activities, including administrative accruals, variance analysis, reporting, risk identification, and communication to senior management • Support forecasting, budgeting, long-term financial projections, and strategic planning • Support pro forma work for RFPs, new business activities, and annual product pricing • Lead vendor due diligence for potential M&A opportunities • Maintain relationships with key vendor contacts, negotiate favorable terms, obtain files for MLR calculations, rate setting, and encounter reporting, and ensure compliance with financial contract components • Hire, train, develop, and evaluate staff

🎯 Requirements

• Bachelor of Science/Arts (BA/BS) degree in Finance, Accounting, Math, or related field • Minimum of ten (10) years of experience • Minimum of five (5) years of management experience • Prior healthcare / insurance industry experience • Excellent PC skills, including advanced Excel, Word and PowerPoint • Excellent oral, written and interpersonal communication skills • Strong analytical and problem-solving skills • Ability to effectively influence others • Strong managerial and team-building skills, including ability to lead and direct the work of others • Strategic thinking skills with strong financial acumen • Proven track record of achievement and integrity • Licensure / Certification: None • MBA is preferred • Experience with companies that have both for-profit and not-for-profit entities is preferred

🏖️ Benefits

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