- Strategy Development: Build a comprehensive set of initiatives, solutions and offerings to manage medical cost for our patients and physician partners
- Population Health Management: Coordinate rigorous analysis of attributed patients, conditions, emerging risk and identify and develop corresponding programs, protocols and processes to facilitate patient care and improve patient outcomes
- Analysis & Research: Complete extensive market, utilization and clinical research to ensure comprehensive sourcing and evaluation of opportunities. Prioritize initiatives based on established criteria
- Solution Development: Engage with internal teams and external representatives to construct priority initiatives, engaging cross functional team members to thoroughly assess and develop a comprehensive market offering. Determine build/buy/partner strategy
- Financial Analysis: Build the business case and ROI model that effectively captures the business opportunity and objectives, financial forecast and performance targets
- Execution: Build and execute implementation plans with input from cross functional leaders, and external partners. Ensure effective and collaborative coordination with physicians and partners to ensure alignment on target populations, clinical protocols, multidisciplinary care team models and patient engagement strategies to optimize clinical and medical cost initiatives. Monitor implementation plans and track performance to key milestones
- Performance Measurement: Deliver to key performance indicators (KPIs) to measure the success and impact of Medical Cost and Care Management programs and capabilities. Regularly report on performance outcomes to key stakeholders and executive leadership.
- Collaboration and Leadership: Collaborate with cross-functional teams, including clinical, operational, financial/actuarial, and constituent experience stakeholders, to drive the adoption of field operations services, solutions and new business models
- Regulatory Compliance: Stay abreast of evolving regulatory requirements related to program offerings (Medicare Advantage, ACO REACH, etc), population health management and value-based care, ensuring compliance with relevant laws and regulations.
- Industry Best Practices: Continuously monitor industry trends, emerging technologies, and best practices in population health management and value-based care solutions, and proactively integrate them into the organization's operations strategy
- Education - Masters of Business Administration, Masters of Public Health or Masters of Health Administration
- 10+ years of work experience at payers, MSO or VBC related companies
- 8+ years experience evaluating, building and deploying initiatives to improve population health
- Experience in VBC programs including ACO/MA/commercial programs
- Strong knowledge of healthcare tools, platforms and solutions, including electronic health records (EHRs), revenue cycle management, and other relevant capabilities
- Deep understanding of claims/clinical data and how to leverage to evaluate business opportunities
- Familiarity with healthcare regulatory and related requirements, such as HIPAA, PHI, HCC, ICD-10, etc and a commitment to maintaining data privacy and security
- Demonstrated ability to reduce medical costs and manage population health outcomes broadly
- Proven success engaging with external partners and clinical organizations to improve patient experience and navigation and facilitate better outcomes and medical costs
- Excellent problem-solving and critical thinking abilities
- Proven track record of driving successful initiatives and achieving measurable outcomes in population health management and value-based care
- Excellent ability to succinctly summarize research, data, insights into cohesive summaries for leadership consumption and decision making
- Excellent communication skills both written and oral
- Demonstrated success organizing a business plan with corresponding ROI model, financial forecast, market landscape review and implementation/execution schedule
- Strong leadership skills with the ability to effectively deploy business strategies, status and emerging opportunities to achieve corresponding metrics, ROI and business value
- Ability to effectively collaborate with cross-functional teams and resources on a range of operational strategies and initiatives
- Ability to hold teams accountable to productivity, quality and financial targets
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VP, Medical Cost Initiatives - Nashville, United States - Wellvana
Description
ApplyDescription
The Why Behind Wellvana:
The healthcare system isn't designed for health. We're designed to change that.
We're Wellvana, and we help doctors deliver life-changing healthcare.
Through our high-touch approach to value-based care, we're moving beyond fee-for-service and helping tie the healthy outcomes of patients directly to healthier profitability for providers and health systems.
Recently named by Insider as one of 33 startups "investors expect to take off in 2023," we're one of the fastest-growing companies in America because what we do works.
Clarity on the Role:
We are seeking a Vice President (VP), Medical Cost Initiatives with expertise in population health management and value-based care.
Reporting to the SVP, Medical Cost and Care Management, the VP, Medical Cost Initiatives will be responsible for identifying opportunities to optimize medical costs and achieve utilization targets for our business.
This position requires a leader with a deep knowledge and insights of care delivery processes, healthcare claims and utilization data and patient engagement strategies to improve care and quality outcomes.
You will need an excellent background in healthcare analytics and the proven ability to deploy targeted programs to ensure that medical costs and performance metrics are delivered to expectations.
You will need to engage with cross functional teams to comprehensively evaluate opportunities and effectively deploy initiatives internally and externally.
What's Expected:
What's Required:
