The Primary Care Payer Programs Manager assists the other Manager and/or Director in providing leadership and management within the division of primary care. The Primary Care Payer Programs Manager works with, Primary Care, Payer Relations, Coding, Compliance, Ambulatory Pharmacy team, as well as Payers to find innovative solutions for closing gaps in care. Position will have a line of sight to Medicare Shared Savings Program Accountable Care Organization (MSSP ACO), along with other CMS programs, and development of additional networks. The Primary Care Payers Program Health Manager assists the Director in providing leadership and management within the Primary Care Division.
This position also directly supervises the outpatient care management department. This position leads outpatient care management department that includes registered nurses, licensed practice nurses, social services workers, patient support specialists, and community health workers.
Essential Job Functions
• In collaboration with physician leadership and other medical staff, administration, and other health care providers, develops and implements short and long range plans, and leads, develops and revises programs which enhance department services.
• Leads department in the overall marketing, program development, and service priorities.
• Coordinates with physicians and other Billings Clinic leadership to assure continuity in pursing service line/organizational goals and synergy in implementing plans and problem resolution.
• Responsibilities include personnel management, orientation/training, scheduling, development/mentoring, performance appraisals, coaching and counseling, disciplinary actions, patient care delivery, physician relationships, intradepartmental and interdepartmental activities, quality control and process improvement activities, and regulatory compliance.
• Develops, implements, and maintains a realistic, cost-effective annual budget.
• Performs advanced support and analytical work in managing, monitoring, coordinating, facilitating and tracking the program’s operational initiatives, and activities.
• Works closely with key operational leaders to manage and communicate team decisions; resolve issues; work with teams to identify and implement workflow changes to meet the goals of the individual projects.
• Practices effective process improvement principles to assess and improve the quality of the service/care provided within the department.
• Develops, retains, recruits, and leads and successful supervises a talented team committed to accomplishing the goals and objectives of Billings Clinic.
• Recommends, implements, and evaluates plans and systems that assure sufficient number of qualified and competent staff to provide care/services. Adheres to administrative policies and procedures relating to human resource management.
• Demonstrates and encourages an ethic of open communication and teamwork throughout the organization. Builds an environment of shared commitment to Billings Clinic’s goals and responsibility to achieve quality outcomes. Provides consultation for related concerns and acts as a customer advocate by demonstrating sensitivity to ethical and legal ramifications of practice.
• Manages the coordination and implementation of programs related to value based care. Develops and reviews action plans and process improvement to identify unresolved or repetitive issues.
• Effectively works closely with the Payer Relations team, Primary Care Director, and Physician leadership to assure data integrity to inform strategic recommendations.
Minimum Qualifications
Education
•4 Year / Bachelors Degree In a related field.
Experience
•2 years successful experience working in a related service area.
•2 years successful experience supervising and management staff members,
•2 years successful budget managing experience, preferred.
Certifications and Licenses
•MT Driver license or the ability to obtain one, at hire
