Director Population Health- Accountable Care Organization- Somerset, NJ

3 weeks ago


Trenton, United States CareerBuilder Full time

Job Summary
The Director of Population Health, is responsible for the successful operation of activities of major significance to the organization.The candidate will lead programs, initiatives, and projects; and will be performing functions that enable the success of key business processes and practices. This position offers exposure to several high functioning departments and all of hospitals, ambulatory groups, joint-ventures, and community partners looking to monitor and improve performance for their MSSP, Commercial, and Managed Care populations.
Essential Job Functions
* Direct and contribute to a broad scope of strategic projects focused on the promoting the success of the business
* Lead and develop a team of professionals responsible for the daily oversight of our Medical Group, Joint Venture, and Clinically Integrated Network and its performance in our various value-based programs with different Payors and CMS
* Performs complex value-based modeling exercises with collaboration of Contracting and Analytics team
* Communicates strategies both internally and externally to manage provider expectations
* Responsible for developing a deep understanding of the contract details under various line of business and financial flows then directing and leading the rest of the department to achieve success
* Partner with other Directors and reporting VP to establish business goals for department/function/organizational unit and monitor status against goals
* Guide and direct the risk analysis and make presentations about risk pool performance using membership, risk score, revenue, and claims data
* Apply analytic concepts and tools to enhance understanding of all elements of the business impacting financial performance of risk pools
* Improve our footprint by recruiting Community Partners through Clinically Integrated Network, manage their cost utilization, and build strategy to improve their Medical Neighborhood utilization
* Build Quality Improvement plan and work with the Quality team to achieve the goals set by CMS and Payors through various Quality Programs and Pay for Performance Programs
* Keep abreast of government reforms and their impact on our various risk programs
* Act as the liaison between Payors and Health System in various area, inclusive of general contracting, quality, risk adjustment, and other discussion/initiatives
* Assist with other various programs as it gets introduced through the Population Health Department
Job Qualifications
* Bachelor's Degree, required
* Progressive managerial skills managing a team, required
* Current or previous work experience within a Hospital, Healthcare, or Managed Care Organization, required (at least 5 years)
* Knowledge of financial and medical economics terms such as revenue, cost, utilization, per member per month, and utilization per thousand, required
* Experience analyzing cost and utilization trends, required
* Ability to analyze large data sets and assist in the documentation of processes for change control purposes, required
* Experience in understanding various HEDIS and Medicare STAR measures and the requirements, required
* Knowledge of Microsoft Access and PowerPoint, required
* Work experience with Microsoft Excel - create pivot tables, formatting, sorting, create spreadsheets with complex formulas such as 'sum' products, v-lookups; etc, preferred
* Excellent interpersonal skills necessary to interact with key constituents both internally and externally, required
* Understanding of Medicaid, Medicare, and commercial products, required
Additional Information:
We offer a great work environment, competitive rates and excellent benefits, including:
* Medical/Dental/Vision plans
* 401k
* Vacation/Personal/Holiday/Sick Time Off
* Short & Long Term Disability
* Basic Life & Accidental Death Insurance
* Tuition Reimbursement
* Health Care/Dependent Care Flexible Spending Accounts
RWJBarnabas Health is an Equal Opportunity Employer

#J-18808-Ljbffr



  • Trenton, United States RWJBarnabas Health Full time

    Job Overview: Leads the development of strategic compensation initiatives, practices and programs for RWJBarnabas Health. Ensures the quality, compliance, competitiveness, and cost effectiveness of compensation programs. Qualifications: Required: Bachelor s Degree in Human Resources Management or a relevant discipline required Solid, proven experience in a...


  • Trenton, United States Virtual Employee Full time

    Job DescriptionJob Description J.Knipper is looking for a FULL-TIME HYBRID new Professional Services Coordinator for 17/hour! Shift: Monday/Friday : 8:30 AM - 5:00 PM - Somerset, NJ POSITION SUMMARY: Works under the direct supervision of the Account Manager and/or Program Manager and is responsible for day-to-day operations of assigned client programs at...


  • Trenton, United States Gtechhelp Full time

    A NJ-based healthcare non-profit organization is looking for a Senior Accountant. You will predominantly handle the non-profit part of the organization. We are looking for a person with experience in the non-profit sector. You should also be fully familiar with all GAAP principles and practices. A strong Excel background, familiarity with all things related...

  • Home Health Aide

    3 weeks ago


    Trenton, United States Moonlight Home Care - Somerset, NJ Full time

    Moonlight Home Care is looking for Home Care Aide who has CHHA Certification to serve a client in Lawrenceville, NJ 08691. This client has been approved for 56 hours a week. Providing assistance to our client with ADL's, light housekeeping, errands, mobility, meal preparation, medication assistance, and companionship.


  • Trenton, United States Actus Consulting Group Full time

    A Japanese manufacturer seeks an Accountant. Work hours: Mon- Friday 9AM - 5PM *Working in the office 5 days/week is required. Salary: Around $60K (DOE) Job Summary: We are seeking an experienced Accountant to join our team. As an Accountant, you will be responsible for managing financial transactions, preparing financial reports, and ensuring compliance...


  • Trenton, United States Five Star Quality Care, Inc. Full time

    Key Responsibilities The Opportunity We are actively hiring for a Director of Resident Care to join our team. The Resident Care Director is responsible for coordinating resident care to ensure residents remain as independent as possible for as long as possible. The Resident Care Director will assist residents and their families in maintaining the physical...


  • Trenton, United States Everas Community Services Full time

    Job description Director of Residential Services Summary Everas Community Services, Inc. has been providing community-based services to people with intellectual and developmental disabilities for more than 40 years. Our extensive experience includes services for people across a spectrum of abilities and specialized needs including people who are deaf-blind,...

  • Accounting Analyst

    6 days ago


    Trenton, United States Vaco Recruiter Services Full time

    MS Dynamics - GP Functional Consultant 3 Month Project Somerset, NJ Seeking an Accounting Analyst with MS Dynamics Great Plains experience to join our team. In this role you will be working alongside the Controller and President of the company to assist them with all things Microsoft Dynamics. Requirements: 6+ years of experience working within MS Dynamics...


  • Trenton, United States Five Star Quality Care, Inc. Full time

    Key Responsibilities The Opportunity We are actively seeking an Assistant Director of Resident Care to join our team. The Assistant Director of Resident Care will work directly with the Director of Resident Care to assist in managing day-to-day functions. It is the responsibility of the Assistant to train, supervise and schedule care staff members as well...

  • Account Director

    2 days ago


    Trenton, United States eTeam Full time

    What's the opportunity? As an Account Director, you will sell into one of our largest clients, and develop new relationships. This role is 70% new business development and 30% existing client management..... a true career opportunity with tremendous professional upside. The role is remote with occasional visits to the client sites in the NY/NJ area, and you...

  • Account Director

    2 weeks ago


    Trenton, United States eTeam Full time

    What's the opportunity? As an Account Director, you will sell into one of our largest clients, and develop new relationships. This role is 70% new business development and 30% existing client management..... a true career opportunity with tremendous professional upside. The role is remote with occasional visits to the client sites in the NY/NJ area, and you...


  • Trenton, United States CVS Full time

    The Behavioral Health Medical Director is a key position on Aetna Better Health of NJs (ABHNJ) leadership team and is responsible for leadership and counsel for utilization management and case management programs for mental health and substance use Behavioral Health, Medical Director, Health, Director, Behavioral, Medical, Retail, Healthcare


  • Trenton, United States CVS Health Full time

    The Behavioral Health Medical Director is a key position on Aetna Better Health of NJ’s (ABHNJ) leadership team and is responsible for leadership and counsel for utilization management and case management programs for mental health and substance use disorder services and collaboration with DMAHS, and other state agencies, to oversee the implementation of...

  • Recruiter

    3 weeks ago


    Trenton, United States Synerfac Full time

    Details: Work directly for a well-established national staffing/recruitment firm. The position is an in-office position located in Somerset, NJ. Recruiter: Primary Duties & Responsibilities: * Contact job seekers using phone and e-mail to present job opportunities. * Utilize various resume databases to create effective candidate searches. * Determine if...


  • Trenton, United States PeopleShare Inc Full time

    Do you have a background in banking or accounting? We are seeking a Cash Applications Specialist with experience in cash applications and high volume data entry in Somerset, NJ. Our client is a global supplier and is eager to add to their growing Accounting team! See below and apply today!Job Details for Cash Applications Specialist:Schedule: Monday to...


  • Trenton, United States Women In Development of Mercer County Full time

    Position Summary: The Development Director is an experienced professional and strategic thinker who will help advance the organization’s mission, guide the organization’s corporate and individual giving fundraising strategy, oversee and execute its related events and relationship-building activities, and manage relationships across fundraising platforms....


  • Trenton, New Jersey, United States CVS Health Full time

    The Behavioral Health Medical Director is a key position on Aetna Better Health of NJ's (ABHNJ) leadership team and is responsible for leadership and counsel for utilization management and case management programs for mental health and substance use disorder services and collaboration with DMAHS, and other state agencies, to oversee the implementation of BH...


  • Trenton, United States Promotion In Motion Full time

    Do you love candy and snacks? Are you looking to join an ever evolving and rapidly growing team? PIM Brands might just be exactly what you’re looking for! At PIM, we make the brands you love. Our portfolio of products, from Welch’s Fruit Snacks to Sun-Maid Chocolate Raisins and Sour Jacks Sour Candies are enjoyed by millions of consumers every day. And...

  • Food Safety

    2 weeks ago


    Trenton, United States Ferrero Full time

    Somerset, NJ Company description Ferrero is a family-owned company with a truly progressive and global outlook and iconic brands such as Nutella, Tic Tac, Ferrero Rocher, Raffaello, Kinder Bueno and Kinder Surprise. As the love for our brands continues to grow, so too does our global reach. Represented in more than 50 countries, with products sold in more...


  • Trenton, United States Diocese of Metuchen Full time

    Geriatric Case Manager (10-12 hours weekly) Somerset, NJ Presently, we have a part-time opening for a Geriatric Case Manager at a residence for retired priests who will be responsible for planning, managing and coordinating the care of priests in residence. The following is a brief summary of the position: Screen, assess priest’s cognitive functioning and...