Changing health care
to improve quality of
life for all.
Beth Israel Lahey Health’s roots in providing top-quality health care date back nearly a century. We're fully committed to ensuring our patients receive the care they deserve. As a leading healthcare provider throughout New England, we aim to change the current state of health care for the better and make lasting improvements that guarantee access to our services.
Director, Payor Operations
Wakefield, Massachusetts
Organization Facility: Beth Israel Lahey Health Performance Network Category: Payer Relations Job ID: JR20772 Date posted: 05/11/2023When you join the growing BILH team, you're not just taking a job, you’re making a difference in people’s lives.
Job Type:
RegularScheduled Hours:
40Work Shift:
Day (United States of America)Reporting to the Executive Director, the Director, Payor Operations will assist in overseeing/managing operations for all BILHPN contracted government payors.The Director will help develop and implement strategic business plans in support of BILHPN’s mission.
This position ensures compliance with all Federal and State obligations, as well as successful outcomes of program goals and metrics.
Job Description:
Responsibilities:
--Manages requirements around being a Risk Bearing Provider Organization (RBPO) and Certified ACO.
--Directs BILHPN wide aspects of government payor program design and development, establishing goals and metrics that support payer goals, requirements and obligations.
--Serves as a liaison and expert to state and federal agencies on matters pertaining to the ACO on behalf of BILHPN.
--Identifies system integration needs and collaborates with IT to develop project plans to meet government payor goals.
--Develops and implements evaluation tools and processes to enable executive review of program performance.
--Works with government payor and consumer stakeholders on delivery system reform efforts that impact BILHPN.
--Mitigates risks and ensure the business is successful in meeting its goals and objectives
--Plans, develops, and reviews materials for education of network members and providers
--Assists the Executive with planning department budget, relevant presentations, strategic planning for future contract amendments or applications
--Supervises 2-4 program managers overseeing Medicaid and Medicare contracts
--Participates in the process of identification of performance improvement projects, including creating the associated analytics and financial justification. Communicates effectively with cross-functional teams
--Carries out cross functional tasks to achieve critical milestones
--Ensures expenses stay within project budget
--Uses critical thinking skills to analyze information, develop solutions and propose alternative action plans
--Participates in establishing and implementing project communication plan including progress reporting mechanism to keep project sponsor, key stakeholders, senior management, external leadership and various committees up to date with the progress of the projects
--Performs all other duties as needed or directed to meet the needs of the department.
Experience:
5-7 years of experience in managed care operations, with working knowledge of finance, practice management, and quality improvement relevant to outpatient care.
Experience in planning, developing, organizing, financing, staffing, problem resolution, delegating, marketing, executing and evaluating performance must be demonstrated.
Prior experience managing a highly complex situation and/or a medical group affiliated with hospitals.
Experience in planning, developing, organizing, financing, staffing, problem resolution, delegating, marketing, executing and evaluating performance
FLSA Status:
ExemptAs a health care organization, we have a responsibility to do everything in our power to care for and protect our patients, our colleagues and our communities. Beth Israel Lahey Health requires that all staff be vaccinated against influenza (flu) and COVID-19 as a condition of employment. Learn more about this requirement.
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Equal Opportunity Employer/Veterans/Disabled
