Center Medical Director

Found in: Lensa US P 2 C2 - 1 week ago

St Paul, United States CareerBuilder Full time

Role: Senior Vice President, Managed Care Operations
Role Description:
Reporting to the Chief Financial Officer, the Sr. Vice PResident, Managed Care Operations leads the function and will build a team that is responsible for managing our relationships with health plans, including contracting, credentialing and all operational related engagements/communications. The ideal candidate will have relevant experience working with managed care plans in a senior role, be self-directed, and enjoy working with a team in a fast-paced environment, using their skills and experiences to effectively work with health plans to enable Oak Street Healths growth and economics.
Core Responsibilities:
Managed Care Operations (External Stakeholders):
* Responsible for being the primary representative of Oak Street Health to our health plan partners
* Architect strategy and build team to effectively engage health plans to drive desired outcomes for Oak Street
* Engage with health plan counterparts to ensure Oak Street Health has the necessary attention, resources and data from health plans to care for our patients and manage our care programs
* Negotiate new and existing contracts and navigate contractual issues/dispute resolution with health plans and CMS for Oak Street and Oakwell
* Represent Oak Street Health at payer Joint Operating Committee meetings, including establishing agendas and working with health plan partners to ensure robust and relevant discussion
Managed Care Operations (Internal Stakeholders):
* Engage the appropriate internal leaders (CEO, COO, CFO, Divisional Presidents, and Regional Vice Presidents) on matters related to health plan relationships and strategy
* Work with the Growth team to identify markets and opportunities to partner with plans to achieve mutual growth targets
* Oversight of health plan contractual performance, both financial and quality, and identify opportunities to drive better economics and evaluate the viability of plans
* Architect and lead payer strategy discussions, including team development/growth as well as critical areas focus for the Managed Care Operations team
* Lead membership reconciliation work in collaboration with the Growth team to ensure Oak Street is appropriately attributed patients in its care
* Work with cross-functional teams to develop, implement, and assess Oak Street strategic and operational initiatives
Credentialing:
* Provide oversight and mentorship for the credentialing team; prior experience in delegated credentialing a plus
* Ensure Oak Street efficiently manages our credentialing operations to minimize processing times with health plans
* Lead our delegated credentialing effort
* Work with credentialing team to identify and resolve issues with health plan operations
Were looking for motivated individuals with:
* 15+ years of experience in an analytical, fast-paced environment; growth-stage company experience a plus
* Experience working closely with senior executive leadership of organizations both internally (within Oak Street Health) and externally (health plans and CMS)
* Prior experience working for organizations that are delegated services by health insurance companies is highly valued
* Experience leading and developing teams to high level of performance and partnering
* Excellent communication and interpersonal skills that build rapport and drive accountability.
* Ability to independently pursue and implement solutions to complex financial, strategic, and operational challenges
* Excellent problem-solving, analytical skills, and business judgment
* Ability to manage multiple priorities in a fast-paced environment
* Knowledge of Medicare space and familiarity with alternative payment arrangements (e.g., shared savings, risk / capitation, value-based contracting) a plus
* Proficient with Microsoft Office
* Bachelors Degree required; advanced degree a plus
* US work authorization
* Someone who embodies being Oaky
What does being Oaky look like?
Radiating positive energy
Assuming good intentions
Creating an unmatched patient experience
Driving clinical excellence
Taking ownership and delivering results
Being relentlessly determined
Why Oak Street Health?
Oak Street Health is on a mission to Rebuild healthcare as it should be'', providing personalized primary care for older adults on Medicare, with the goal of keeping patients healthy and living life to the fullest. Our innovative care model is centered right in our patients communities, and focused on the quality of care over volume of services. Were an organization on the move With an ambitious growth trajectory, Oak Street Health is attracting and cultivating team members who embody Oaky values and passion for our mission.
Oak Street Health Benefits:
* Mission-focused career impacting change and measurably improving health outcomes for medicare patients
* Paid vacation, sick time, and investment/retirement 401K match options
* Health insurance, vision, and dental benefits
* Opportunities for leadership development and continuing education stipends
* New centers and flexible work environments
* Opportunities for high levels of responsibility and rapid advancement
Oak Street Health is an equal opportunity employer. We embrace diversity and encourage all interested readers to apply.
Learn more at www.oakstreethealth.com/diversity-equity-and-inclusion-at-oak-street-health

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