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Payment Reform Director - Nashville TN
Category: Health Care Industry , Insurance
  • Your pay will be discussed at your interview

Job code: lhw-e0-89769150

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UnitedHealth Group

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  Job posted:   Thu May 17, 2018
  Distance to work:   ? miles
  1 Views, 0 Applications  
Payment Reform Director - Nashville TN
This is a tremendous opportunity to work with the State of Tennessee on the implementation and management of its Health Care Innovation Initiative to transform the state's health care payment system to reward patient-centered, high-quality, high-value health care for all Tennesseans. You'll get exposure to cross-segment business functions, and influence and drive innovative changes that improve the health care system for the benefit of Medicaid members.
As part of C & S Health Plan, this role will drive various work streams, lead cross segment initiatives, and support the overall relationship with the State of Tennessee as it embarks in its journey to transform the health care payment system. Primary Responsibilities: Serve as a member of the C & S Health Plan payment reform team for developing, implementing, and managing payment reform programs for the State of Tennessee Develop positive business relationships with the C & S Health Plan leadership, State of Tennessee, Optum, UHN, provider organizations, MCOs, and other matrix partners involved with payment reform.
Assist in the development of strategic payment reform initiatives aimed at improving the overall costs and quality metrics of a Medicaid population Participate in developing an innovative provider communication and engagement plans regarding payment reform (e.g., broad and targeted provider education and communication through an array of delivery vehicles such as, but not limited to, provider forums, webinars, letters and provider relations staff outreach) Provide program management and/or assistance to internal and/or external partners (e.g., claims, call center, clinical) to ensure payment reform programs and strategies are implemented and maintained effectively Assist and support the payment reform operational requirements for the State of Tennessee as well as participate in tactical and strategic group meetings for supporting an aligned vision with the other participating MCOs Review payment reform performance reports in order to determine overall effectiveness, make recommendations, and identify opportunities for improving programs and make appropriate recommendations to the VP for Payment Reform and Transformation Participate in relevant UnitedHealth Group stakeholder meetings for developing and reviewing potential operational solutions and improvements, programs, and plans (e.g., cost-saving initiatives; reporting; quality metrics) Monitor and/or report on-going compliance and related outcomes (e.g.
provider complaints; reconsiderations; clinical metrics) to relevant UnitedHealth Group stakeholders and ensure the VP of Payment Reform and other internal leaders are aware of trends Participate in solving complex payment reform issues for improving processes within the team Actively participate, assist, and support the C & S Health Plan payment reform team's yearly operational and performance goals Required Qualifications: BA/BS 3+ years of healthcare program management experience Proficiency in MS PowerPoint, Word, and Excel Ability to work cohesively with others in a healthcare matrix environment is essential 3+ years managing provider relationships Proficient understanding of provider payment methodologies Proficient in managing multiple projects/tasks to meet deadlines Proven ability to understand and address provider challenges as it relates to value-based programs and drive ideas forward in a clear and concise manner Preferred Qualifications: A Master's degree or greater in Business Administration, Health Policy, or similar fields of study Knowledge of the State of Tennessee Innovation Initiative for payment reform Broad knowledge of UnitedHealth Group operational systems and processes (Provider Data, Claims, Finance, etc.) Healthcare and/or Medicaid experience is highly preferred Subject matter expertise in areas including program management, provider relations/engagement, provider communications, and operational processes Excellent communication (including presentation) skills required for client, matrix partners, and provider interactions.
The ability to work independently and make decisions Ability to multi-task, prioritize and work in a fast-paced environment Careers at UnitedHealthcare Community & State.
Challenge brings out the best in us.
It also attracts the best.
That's why you'll find some of the most amazingly talented people in health care here.
We serve the health care needs of low income adults and children with debilitating illnesses such as cardiovascular disease, diabetes, HIV/AIDS and high-risk pregnancy.
Our holistic, outcomes-based approach considers social, behavioral, economic, physical and environmental factors.
Join us.
Work with proactive health care, community and government partners to heal health care and create positive change for those who need it most.
This is the place to do your life's best work.(sm) Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity/Affirmative Action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law. UnitedHealth Group is a drug-free workplace.
Candidates are required to pass a drug test before beginning employment. Job Keywords: the C & S Health Plan payment, C & S Health Plan leadership, Medicaid, Provider Data, Claims, Finance, Healthcare, Nashville, TN, Tennessee 453f2761-6e0e-4648-834f-ddd0e2c912ea
*Payment Reform Director - Nashville TN*

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