Director, VBR & Risk Adjustment

Job not on LinkedIn

🔥 12 hours ago

🇺🇸 United States – Remote

💵 $113k - $197.7k / year

⏰ Full Time

🔴 Lead

🎲 Risk

🦅 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 and monitor physician and standard health partner contracting and ongoing relationships with the plan's physician and health partner network • Ensure provider satisfaction is met • Assist with analysis and implementation of initiatives improving quality outcomes and risk adjustment scoring • Oversee and monitor network access standards, including recruitment for network gaps and/or new product development • Develop regional business plans to expand the service area, increase plan enrollment and improve network quality outcomes • Represent CareSource in the local market through community engagement, board memberships and trade/professional organizations • Monitor plan financial activities, including budgeting and forecasting, to ensure financial goals are met • Maintain cooperative relationships with provider and regulatory agencies • Translate issues, goals and objectives into practical, integrated solutions and services • Oversee development and application of policies, standards, benchmarks, metrics and quality controls • Design project plans, conduct studies, make recommendations and develop implementation plans for operational improvements • Develop and coordinate performance improvement measurement, reporting and feedback systems • Administer contract management databases, instruct site-specific user administrators, create user profiles and coordinate IT upgrades • Secure resources, define roles and responsibilities, set direction and coordinate initiatives for operational performance and division goals • Lead or participate in vendor selection, contract development and compliance for provider network operations tools and services • Communicate professionally with all organizational levels • Oversee and manage support teams, including hiring, supervision, development and colleague evaluation • Prepare periodic reports and presentations for executive leadership • Maintain knowledge of applicable federal, state and local laws and regulations • Perform other related duties as requested

🎯 Requirements

• Bachelor's degree in management, healthcare management or related field required • Equivalent years of relevant work experience may be accepted in lieu of required education • Five (5) years in healthcare network management experience required • Five (5) years of leadership/management experience required • Managed Care experience preferred • Strong knowledge of Value Based Contracting methodologies and operations and/or experience in health care quality • Advanced proficiency with Microsoft Office, including Outlook, Word and Excel • Ability to operate a smartphone, iPad, or other mobile communication devices • Knowledge of provider contracting and provider network operations • Knowledge of regulatory requirements for Marketplace provider network operations • Excellent oral, written and interpersonal communication skills • Strong financial background • Knowledge of managed care industry, trends, accreditation, quality improvement and NCQA provider network requirements • Ability to work independently and within a team environment • Attention to detail and work plan creation, implementation, and evaluation • Business acumen and strategic thinking with tactical execution ability • Ability to adjust to shifting priorities, multitask, work under pressure and meet deadlines • Proven ability to recognize improvement opportunities and lead change • Proven track record leading teams focused on consumer/member experience, with empathy, compassion and tracked results • Proven track record driving continuous improvement to improve member experience and tracking results • Master's degree in business, healthcare management or associated field preferred • No licensure or certification required

🏖️ Benefits

• Bonus tied to company and individual performance may be available • Substantial and comprehensive total rewards package • Total well-being support • Remote work arrangement • Up to 25% travel to meetings, trainings, and conferences