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Proven experience building product and service capabilities for cost of care focused precision medicine, digital health software, analytics platforms and EHRs and clinical decision support tools.
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Requires a minimum of 8 years of experience in health care/managed care with direct responsibility within a Financial Planning & Analysis (FP&A) and/or Medical Cost Management & Analysis discipline.
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Executive leadership of Provider Performance and Analytics functions, supporting Humana's value based contracts and trend bender initiatives. Experience leading the 'end-to-end' contract negotiation process through closure for all types of providers (hospitals, physicians, post-acute care facilities) and delegated specialty services across Medicare, Medicaid and Employer Group segments.
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Understanding of population-based medicine, preferably with knowledge of CMS criteria for post-acute care. + Regularly meet with naviHealth's leadership to review care coordination issues, develop collaborative intervention plans, and share ideas about network management issues.
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Develop and communicate a product roadmap as it relates to solutions supporting hospital coding, physician coding, and modular coding offerings; articulate the unique value proposition based on deep understanding of medical coding and coding technology, coding audits, upstream real-time coding as well as safety net coding solutions, the complex medical coding landscape, and operational opportunities.
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3-years' performing value-based care analytics. Tracks various value-based care contract payments, including shared-savings, risk pools, incentives, and capitation.
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Serving as an empathetic and consultative accountable care expert, this role will recruit practices to participate in government and commercial value-based care contracts with the backing of Aledade’s industry expertise, hands-on support, and proprietary technology and analytics.
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Statistical analysis experience, including but not limited to experimental design, regression modeling, and machine learning using tools such as GCP, Adobe analytics, Python, R, Spark SQL and MLlib for custom analysis, in conjunction with SQL for data query and extraction techniques.
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Oversees the development and management of provider networks, including provider performance based network strategies to improve overall health care affordability and member experience, and the planning and implementation of provider network activities and resources through provider data analytics, financial analyses, competitive intelligence, market research, population health informatics and medical cost trend analyses.
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Knowledge of value-based care models, accountable care, and population health management. We were founded in 2014, and since then, we've become the largest network of independent primary care in the country - helping practices, health centers and clinics deliver better care to their patients and thrive in value-based care.
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Partnering closely with our physicians, CPMG's professional staff use their expertise in business operations management, scheduling, analytics, human resources, communications, legal, finance, and strategy to support high-quality care delivery.
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Potential areas of involvement include market opportunity assessments, service line and regional strategic planning, financial modeling—with a keen focus on value-based care, and other strategic imperatives.
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Experience working on value-based care or population health programs preferred. Supervises the development and progress of investigative analytics and ad hoc requests as it relates to quality of care and service.
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The RN Care Coordinator utilizes evidence-based medicine, data analytics and innovation in implementing care management principles, and applies critical thinking skills and leadership skills in working with the team to meet patients and their families’ needs.
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The RN Care Coordinator guides the Team in utilizing evidence-based medicine, data analytics and innovation in implementing care management principles, and applies critical thinking and leadership skills in managing the Team to meet patients and their families’ needs.
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