As a part of the Tenet and Catholic Health Initiatives family, Conifer Health brings 30 years of healthcare industry expertise to clients in more than 135 local regions nationwide. We help our clients strengthen their financial and clinical performance, serve their communities and succeed at the business of healthcare. Conifer Health helps organizations transition from volume to value-based care, enhance the consumer and patient healthcare experience and improve quality, cost and access to healthcare. Are you ready to be part of our solutions? Welcome to the company that gives you the resources and incentives to redefine healthcare services, with a competitive benefits package and leadership to take your career to the next step!
Accountable for the client relationship and financial performance, which may include, but not limited to increase membership year over year, maximize client capitation revenue and manage client medical spend, coordinate the client team to ensure that client issues are resolved timely. Responsible to realize and achieve the assigned client revenue, contract, and quality program targets. We are looking for someone that understands HMO operations and/or how the delegated services such as claims processing, utilization management, credentialing, customer service, provider contracting, and payor contracting work. This position will be in direct communication with physicians or office managers, and executives and will be preparing and making presentations.
ESSENTIAL DUTIES AND RESPONSIBILITIES
Include the following. Others may be assigned.
• Accountable and responsible for achieving and delivering on the client strategic growth and financial (revenue) performance targets. Responsible for client membership and provider growth. Accountable for the timely and accurate implementation of the delegated services to the client and escalation path when barriers, obstacles, and/or challenges may result in missed deliverables. Responsible for identification of issues and provide workable solutions and/or options to ensure client performance and/or objectives are met.
• Maintain provider network adequacy for client and ensure compliance with SB 137. Manage and track client issues and coordinate with operational teams to address and resolve client issues. Participate in the CVBC Quality Improvement committee and programs and work with the provider networks to close gaps in care, improve quality measures, and encounter data submissions, and other quality program domains, such as, access and availability and satisfaction surveys scores. Prepare and gather materials to comply with payor health provider network audits.
• Prepare and conduct monthly executive board and partner joint operation meetings, review financial statements, including profit and loss, balance sheet, IBNR analysis, analyze utilization trends, make board recommendations, track action items, and maintain tracking logs and minutes. Maintain high level of client executive engagement to ensure client referenceability
• Accountable for existing client growth targets are achieved and new services/upsell opportunities are realized, including but not limited, adherence to the change control notice (CCN) and deal review committee processes (DRC I and II). Serve as subject matter expert for new client logos.
• Work with operational and functional department teams to ensure that client business objectives are executed on time.
This position reports to the Senior Director, West Region Provider Practice and requires minimal degree of supervision to ensure strategic initiatives and client expectations are prioritized, met, and successfully implemented.
KNOWLEDGE, SKILLS, ABILITIES
Candidates that exhibit most of the following preferred qualifications will be well suited for this position. However,
• 4-6 years of health plan or management service organization experience in managing risk bearing organizations or related area
• 4+ years in managed care experience preferred
• Solid working knowledge of the risk bearing organization and the delegated UM, Credentialing, Network Management, Customer Service, Finance, and Case Management functions.
• Solid working knowledge of risk bearing operating and performance revenue and expense levers
• Solid working knowledge of payor strategies and market layout.
EDUCATION / EXPERIENCE
Bachelor Degree or higher
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
• Must be able to work in a sitting position, use a computer and answer telephone
• Light physical effort (lift to 10 lbs.).
• The home office for this position will be located in Encino, CA.
The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
• Office Work Environment
• Hospital Work Environment
• This position requires regional (West Region) and local (50-mile radius) travel and/or may include travel to other service markets 20% of the time.
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