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Full time VP Population Health at our Roma Location Overview of Responsible for managing the organization’s transition from fee for service to value based care. Accountable for financial performance of risk and value based care business. Provides overall direction for community operations, clinical areas, and administrative activities in the provider organization’s population health functions, including quality, risk adjustment, utilization management, and affordability. This leader will serve as one of the five senior executives on the Optum New Mexico executive team.ESSENTIAL FUNCTIONS:
Oversees the organization’s network contracting team, which includes leading provider network selection, contract price negotiation, incentive payment design, credentialing, and provider data management.
Leads the organization’s delegated care management function, which includes leading teams for utilization management, case management, and disease management while maintaining payor requirements for delegation.
Develops a strategy for evaluating and establishing return on investment under value based payment programs.
Establishes a market wide population health roadmap driving meaningful and measurable health improvement across our patients and communities.
Oversees the development, implementation, monitoring, and revision of annual goals for all population health work streams that support the objectives of the local and broader Optum enterprise.
Responsible for the facilitation and management of the risk, quality, affordability, and patient experience teams. Cultivates a patient-first culture of positivity, teamwork, and collaboration.
Has operational oversight of all population health programs across Optum New Mexico designed to ensure conditions are appropriate evaluated, diagnosed, and captured on behalf of each of our patients, allowing us to provide the best and most cost effective care. Programs include, but are not limited to, preventative screenings, point of care tools, patient outreach, vendor management, training and educational activities, coordination of targeted audits.
Partners with operational and clinical leadership on implementing the most effective care delivery model to serve patients in risk/value based care products.
Oversees continuous coordination of care across different environments to ensure delivery of care in the most appropriate setting. Leverages both traditional and alternative care models (i.e. telehealth, home health) to provide the right level of care to the patient and ensure consistent access.
Leads multi-disciplinary team to evaluate and optimize Optum New Mexico’s service line options for risk, including evaluation of clinician employment, affiliation, and network participation.
Develops and leads all aspects of Optum New Mexico care network program for affiliate providers.
Develops and implements policies and procedures as it relates to local quality and risk adjustment activities.
Oversees risk based payor relations and reimbursement. Develops a comprehensive payor contracting strategy for all risk/incentive based payor contracts.
Drives improvements in clinical and quality outcomes, coding and documentation, and cost reduction measures through data and analytics.
Prepares timely and accurate monthly and annual reporting as required including enterprise level performance, financial analysis, actuarial reports, STARS / HEDIS measures, prevalence analysis, provider dashboards.
Works with the clinical informatics team to prioritize studies and coordinate analytic support.
Understands health inequities across NM’s patient population and identify strategies to appropriately target care and resources to our most critical and highest need patients.
Supports the clinical education team in the execution of provider education activities, clinician chart audits, identifying and data mining patient lists, communicating performance results to rendering physicians and tracking findings.
Partners with operational and clinical leadership on the implementation and communication of provider and clinic incentives that support risk/value based care objectives.
Monitors the latest developments, advancements, and trends in population health and healthcare management including CMS announcements and organizational policy changes across Optum New Mexico more broadly.
Utilizes expertise to develop effective internal controls to promote adherence to Optum New Mexico’s compliance policies, as well as applicable state and federal laws and program requirements.
Consistently exhibits behavior and communication skills that demonstrate Optum New Mexico’s commitment to superior customer service, including quality, care and concern with each and every internal and external customer.
Uses, protects, and discloses Optum New Mexico patients’ protected health information (PHI) only in accordance with Health Insurance Portability and Accountability Act (HIPAA) standards.
EDUCATION:
Bachelor's degree from a four-year college and/or a professional certification requiring formal education beyond a two-year college.
Master’s degree in Healthcare Administration, Business Administration preferred.
EXPERIENCE:Minimum:
Background in leading population health activities in provider or health plan environment.
10 or more years of related work experience within a healthcare setting.
10 or more years of management experience.
Experience in analytics and data analysis.
Preferred:
Fluency in Microsoft applications.
KNOWLEDGE, SKILLS, ABILITIES:
Computer literate.
Excellent analytical and problem-solving skills.
Ability to effectively direct preparation of various financial analysis and data mining activities.
Excellent verbal and written communication skills.
Ability to effectively interface with staff, clinicians and management.
Careers with Optum. Here's the idea. We built an entire organization around one giant objective; make health care work better for everyone. Optum, part of the UnitedHealth Group family of businesses, brings together some of the greatest minds and most advanced ideas on where health care has to go in order to reach its fullest potential. For you, that means working on high performance teams against sophisticated challenges that matter. Here you’ll find incredible ideas in one incredible company and a singular opportunity to do your life's best work.(SM)Diversity creates a healthier atmosphere: Optum and its affiliated medical practices are Equal Employment Opportunity/Affirmative Action employers and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law. Optum and its affiliated medical practices is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.
Vacancy caducado!