Identifies, evaluates, and strategizes risk-based/alternative reimbursement program initiatives. Partners with management and Senior Program Managers to design program plans requiring assessment, research and analysis. Coordinates implementation of risk-based program plans and evaluates outcomes.
1. Prepares program assessment, analysis, and strategy recommendations:
2. Coordinates implementation of risk-based programs:
- Interfaces with management to collect statistical, utilization, financial, quality and risk performance data for analysis.
- Evaluates analyses and identifies high risk populations and makes strategic program recommendations.
- Conducts research, identifies industry standards and new innovative practices for analysis.
- Prepares operational analysis, flow charts, presentations and reports, as required by program specifications.
- Presents analysis and recommendations to management. Obtains feedback and collaborates with management to develop program improvement plans.
3. Evaluates effectiveness of programs:
- Partners with management to implement program initiatives.
- Partners with management to design education programs and coordinates implementation, participates in educational initiatives, as needed.
- Monitors program plan performance and prepares status reports.
- Partners with management to develop tools and metrics to evaluate performance.
- Collects data for review and analysis.
- Prepares analysis and reports for management.
- Prepares additional recommendations and adjustments to plan, as needed.
4. Performs related duties, as required.
- Bachelor’s Degree in Health, Business, Financial Administration or related field, required. Master’s Degree, preferred.
- Minimum of three (3) years healthcare industry related experience including project/program management, required.
- Interpersonal, communication, analytical and presentation skills, required.
- Knowledge of ambulatory care, practice management, practice optimization and insurance reimbursement within an ambulatory and/or acute care setting, preferred.
- Proficiency in data analysis, Microsoft Office and data presentations experience strongly preferred.