Director, PPO Programs - 25-85

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At Hill Physicians Medical Group, we're shaping the healthcare of the future: actively managed care that prevents disease, supports those with chronic conditions and anticipates the needs of our members.

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At PriMed, your uniqueness is valued, celebrated, encouraged, supported, and embraced. Whatever your relationship with Hill Physicians, we welcome ALL that you are.

We value and respect your race, ethnicity, gender identity, sexual orientation, age, religion, disabilities, experiences, perspectives, and other attributes. Our celebration of diversity and foundation of inclusion allows us to leverage our differences and capitalize on our similarities to better serve our communities. We do it because it's right!

Job Description:

The Director of the PPO Programs is responsible for ensuring the company meets the financial and clinical goals of its PPO product line, inclusive of the PPO Accountable Care Organizations (ACOs) and the Clinically Integrated Network (CIN). The Director also has oversight for performance of select ACOs outside of the 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 CIN for provider-facing activities including education, performance, new program implementations and readiness, and dependencies 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, case management, quality management, physician leadership and services, IT and informatics. 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 ACO, and for a clinically integrated model.

Key Tasks and Responsibilities:

• Manage and grow the clinically integrated network in a strategic manner - assessing growth and performance opportunities, network access and efficiency criteria, as well adherence to clinical programs and requirements.
• Provide value proposition to the prospective Clinically Integrated Network Providers and ensure participants are aligned with their focus to improve value-based performance in both utilization and quality metrics
• 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.
• Establish and manage the infrastructure necessary to support the comprehensive PPO programs strategy including physician education, medical management structure and network configuration.
• Provide leadership and management for day-to-day operations and team, work with a high degree of self-direction, mentor and develop talent and regularly report to senior management on the status of PPO strategies and performance.
• Establish strong 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.
• Develop and present key deliverables tailored to different audiences including executives, internal stakeholders and external stakeholders. Content should include cohesive messaging and demonstrate the PPO programs' value, key concepts, and performance updates,
• Lead development and interpretation of 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.

Skills and Experience:

• Bachelor's degree required, business, healthcare administration, or related field preferred. Advanced degree desired.
• At least 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. Ability to develop and present on compelling content with cohesive and concise messaging and supported by data, if applicable.
• 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.

Additional Information:

Salary: $150,000 - $200,000 Annual

Hill Physicians is an Equal Opportunity Employer