Job Summary
This role, in collaboration with Medical Center Leadership, is responsible for providing leadership and management in the delivery and achievement of the financial, strategic, and operational goals of a given market. In addition, the role is responsible formember engagement, new member enrollment, utilization management, and relationship building with hospitals, payors, and community physician partners. This role is multi-faceted and highly visible, partnering with our national team of subject matter experts (SMEs) and local leadership team to positively impact all key performance indicators (KPIs).
Duties and Responsibilities
- Own and operate the design, development, and implementation of the ongoing strategy within the market to ensure all AbsoluteCare goals are met, including financial, clinical, member satisfaction, and growth.
- Analyze competitive position within the market with respect to payer needs, direct competitors, and other adjacent solutions. Work with the local and national leadership teams to maximize our position within the market. Determine opportunities for geographic expansions and/or M&A.
- Partner with each Medical Center Leadership team to execute their business plan and meet their clinical, growth, and financial objectives by ensuring action plans are generated and followed.
- Manage execution of key operational outcomes to ensure member, provider, and regulatory expectations are met/exceeded. Develop and optimize all market KPIs to meet the triple aim.
- Coordinate and interface with various National Leaders to ensure the appropriate resources are available to the market.
- Work with the national team to develop a payer account management strategy that includes growing same-store membership, expanding product/programs, maximizing quality and risk pool payments, maintaining best-in-market relationships, and securing new payer relationships.
- Create a best-in-class culture to attract and retain physicians and other providers.
- Review financial and operations reports to ensure progress toward the annual business plan and remediate areas of underperformance.
- Develop, implement, and manage the adoption of controls that allow the organization to quickly identify trends and potential issues and address them in a timely manner.
- Establish and manage service strategies in coordination with organizational goals and competencies. Aid in establishing operating budgets for the markets organic growth and service operations.
- Function as a support leader for all departments within the market including Operations, Clinical, Network, and Growth as directed by Executive Leadership.
- Assist local Medical Center Leadership in determining community staffing needs and recruitment activities as needed. Ensure the attraction, selection, retention, and assignment of a competent, qualified workforce is a driving factor for operational optimization.
- Mentor, coach, and develop the community operations team in the market. Grow the team to match the needs of the business.
- Assist in customer resolution responses and coach management on appropriate responses. Handle escalated issues and determine proper resolution.
Minimum Qualifications
- Strong business acumen and relationship management/building skills.
- Advanced knowledge of business and management principles involved in strategic planning, resource allocation, human resource modeling, leadership techniques, and operations.
- Superior knowledge of member/patient needs assessment, meeting quality standards for services, and evaluation of member/patient satisfaction.
- Knowledge and implementation of regulatory requirements and laws that govern Medical Center and IPA/ACO activities.
- Knowledge of medical center operations, risk-based contracts, and provider network management.
- Knowledge and experience working with Medicare and Medicaid payers.
- Exceptional track record of driving revenue growth, controlling expenses, and managing P&L.
- Ability to effectively leverage business and organizational knowledge within and across functions.
- Skilled in negotiating; able to effectively influence executives, leaders, and all levels within the organization in matters of transformational change and operational optimization.
- Exceptional written and verbal communication skills.
- Exceptional organizational and management skills, including the handling of multiple projects simultaneously and meeting tight deadlines.
- Keen understanding of business controls and operations.
- Must possess a high degree of emotional intelligence and integrity, driven and focused work ethic.
- Self-starter with the ability to think creatively and work effectively.
- Proficient in Microsoft Office Suite products including Word, Excel, PowerPoint, and Outlook, plus a variety of other word-processing, spreadsheet, database, email, and presentation software.
- Ability and willingness to travel locally, regionally, and nationwide up to 50% of the time.
- This job requires use and exercise of independent judgment.
- Bachelors degree in Business, Healthcare or Public Administration, Finance, Economics, or a related field; additional experience above the minimum will be considered in lieu of the required education on a year-for-year basis.
- MBA or Masters degree in Healthcare or Public Administration or a related discipline preferred.
- A minimum of 10 years healthcare administration, budget management, finance, or closely related industry work experience required.
- A minimum of 5 years direct management/leadership experience within a member/client service environment required.
- Experience managing a diverse group of functional area professionals strongly preferred.
- Experience managing and overseeing a multimillion-dollar P&L business in either medical center or IPA management highly desired.
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