Director of ACO

San Ramon, CA 94583

Employment Type: Direct Job Category: Medical Management Job Number: 46315

The Director, PPO ACOs and CIN is responsible for ensuring the company meets the financial and clinical goals of its PPO product line. The Director oversees all current operational and strategic activities supporting the PPO ACOs and develops and implements new strategies to meet changing market demands. In addition, the position supports the PPO Clinically Integrated Network (CIN) for provider-facing activities including education, program readiness, and links to ACO activities. The Director must be able to manage and lead cross-functional efforts in a matrix organization, set clear priorities and establish strong working relationships with team members in numerous areas of the company including clinical management, utilization management, case management, quality management, physician leadership, financial analysis, clinical analysis, regional services and clinical innovations. The Director will be required to possess a broad understanding of the insurance industry, PPO operations and key aspects of the payment systems for care management activities, for an attributed model PPO, and for a fully clinically integrated model.

Key Tasks and Responsibilities:

  • Manage all aspects of the financial, quality, physician and member satisfaction performance of the PPO programs. Develop and execute strategic and operational plans, programs and initiatives to continue to grow and improve the PPO line of business.
  • Develop appropriate reports to monitor performance. Analyze data to identify trends and opportunities. Work across teams to design, implement and track new initiatives and programs required to improve performance and meet cost and clinical targets.
  • Support and collaborate with the Contracting Department to negotiate and maintain all contractual relationships for the PPO line of business, including providing input and analysis to support proposed changes to contractual terms.
  • Develop the clinically integrated network in a strategic manner assessing network access and efficiency criteria, as well as geographic expansion opportunities.
  • Establish and manage the infrastructure necessary to support the comprehensive PPO programs strategy including physician education, medical management structure and network configuration,
  • Establish working relationships with key health plan executives and internal teams to ensure collaboration, data exchange, and joint development of performance improvement strategies in the areas of utilization management, clinical management, quality performance, shared risk performance and efficiency metrics.
  • Provide leadership and management for day-to-day operations and team, mentor and develop talent and regularly report to senior management on the status of PPO strategies and performance.

Skills and Experience:

  • Bachelor s degree in business, healthcare administration, nursing, or related field required. Advanced degree desired.
  • Five to ten years of progressive experience within a healthcare organization, preferably inclusive of managed care responsibilities, with significant operations experience.
  • Critical thinking and analytical skills to glean insights from complex data derived from multiple sources.
  • Leadership and interpersonal skills necessary to work across numerous functional areas and gain the collaboration of team members throughout the company.
  • Proactive, problem-solving, entrepreneurial style that demonstrates leadership and the ability to exercise independent judgment in a complex environment.
  • Strong presentation, written and oral communication skills.
  • Adept at using programs such as Word, PowerPoint, Excel, and Visio.
  • Broad-based business understanding with in-depth knowledge of the managed healthcare environment.
  • Proven experience in recruiting, supervising, managing and evaluating personnel to support the department functions.
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