Position Purpose: The Program Manager will support Steward's Next Generation ACO (NGACO) risk contract with The Center for Medicare and Medicaid Innovation (CMMI) in four key ways:
* Drive program performance through execution of high-value initiatives derived from data-driven recommendations
* Lead and project manage ongoing and new operational initiatives that improve the quality of care for our Medicare population
* Serve as the point of contact between Steward and CMMI to help maintain our good working relationship, and
* Monitor and ensure compliance with all applicable CMMI/CMS regulations.
Seeking motivated professionals with work experience in the Medicare or healthcare field with a strong desire to learn. Individuals who are organized, collaborate well with others and rely on data analysis to make decisions will resonate the most with our team.
Provides operational, analytical, and strategic guidance for the NGACO program:
* Manages program initiative efforts to improve the care of our patients in close collaboration with clinical subject matter experts across multiple internal departments and external stakeholders including physicians, hospital leadership, and patients
* Works closely with analytics to evaluate and develop program recommendations based on data-driven ROI projections and cost-benefit-risk analyses to inform leadership of the appropriate direction.
* Leads beneficiary engagement efforts to better interact with and educate Medicare patients about the program and the benefits.
* Designs models and performs analyses for the purpose of understanding the historical and future performance of initiatives and the financial impact on program budget.
Identifies program risks, and develops and implements appropriate corresponding mitigation strategies, together with the Medicare management team
* Uses performance data versus expectations (financial, clinical, or operational) to prioritize opportunities and effectively drive operations.
* Works closely with actuarial vendor to understand financial analyses and projections to better inform decision making
* Presents recommendations to targeted set of stakeholders including clinicians and business leaders
Project manages and coordinates activities across SHCN teams, steering workgroups and stakeholders to effectively operationalize objectives, including:
* Manages financial opportunity and risk analyses and implements high-value initiatives and partnerships in collaboration with operational teams
* Interfaces with departments across the organization (e.g. care management, legal, compliance, information technology, etc.)
* Provides support for the key leadership meetings including: the SHCN and SICN Board Meetings, Monthly Performance meetings, and Medicare Compliance Subcommittee meetings
* Assists in the monitoring and implementation of ACO compliance and privacy program
Maintains current and establishes new relationships with external organizations including federal Medicare divisions (CMS and CMMI) and community strategic partners, such as other vendors and ACO participants
* Assists in vendor contract negotiation and management activities.
* Monitors and tracks vendor compliance with contract requirements and works with compliance team to implement corrective actions as necessary to ensure compliance.
Monitors, researches, interprets and recommends best course of action based on changes in market trends, health care delivery systems and legislative initiatives which impact program efforts (e.g., CMS BPCIA program changes)
* Preferred - MBA, MHA, or other Master's degree
* Required - Bachelor's degree or equivalent education
Years of Experience:
* At least two years of work experience in a fast-paced, health care environment
* General knowledge of the health care industry including managed care organizations, hospital settings, and/or physician practices.
Work Related Experience:
* Program management experience preferred
* Healthcare delivery (Medicare-related) experience preferred
* Strong interpersonal skills and ability to interact positively with a wide range of constituents across several different departments
* Organized, flexible, self-motivated, driven must possess ability to plan and lead new activities consistent with achieving organizational and programmatic goals
* Strong project management skills including development of project parameters, goals, and time lines and outcome measurement.
* Ability to effectively and efficiently lead multiple projects and initiatives simultaneously
* Proven ability to work with others in order to steer them towards achieving program goals. Ability to work both independently and within a team environment and a multi-dimensional environment.
* Analytic skills to collect information from diverse sources and summarize the information and data in order to solve problems. Excellent written and verbal communication skills. May be tasked with presenting information to internal and occasionally external audiences.
* Proficiency in Excel, Word, PowerPoint, and Microsoft Project; may be tasked with learning new information systems as necessary
* Ability to function effectively within an ever-changing environment and to meet deadlines and reprioritize as necessary.
* Passion for working towards improving the health of populations.
* Must be able to maintain confidentiality of information.