Program Specialist (Redirection & Data), PPO Programs - 25-177

We’re delighted you’re considering joining us!

At Hill Physicians Medical Group, we’re shaping the healthcare of the future: actively managed care that prevents disease, supports those with chronic conditions and anticipates the needs of our members.

Join Our Team!

Hill Physicians has much to offer prospective employees. We’re regularly recognized as one of the “Best Places to Work in the Bay Area” and have been recognized as one of the “Healthiest Places to Work in the Bay Area.” When you join our team, you’re making a great choice for your professional career and your personal satisfaction.

DE&I Statement:

At PriMed, your uniqueness is valued, celebrated, encouraged, supported, and embraced. Whatever your relationship with Hill Physicians, we welcome ALL that you are.

We value and respect your race, ethnicity, gender identity, sexual orientation, age, religion, disabilities, experiences, perspectives, and other attributes. Our celebration of diversity and foundation of inclusion allows us to leverage our differences and capitalize on our similarities to better serve our communities. We do it because it's right!

Job Description:

This role is responsible for developing and growing our health plan relationships in support of our broader ACO strategy and programs. The PPO Programs Department is a highly visible, fast-growing line of business at Hill Physicians Medical Group. The goals are to reduce total cost of care, improve quality of care, improve patient satisfaction, and increase member engagement for the PPO populations that Hill Physicians manages with each participating health plan.

The PPO Programs team works cross-functionally with Contracting, Case Management, Regional Services, Clinical Support, Informatics, IT, and the physician network. This role promotes the value of our ACO initiatives internally and externally, manages data, evaluates current performance, and implements new programs.

Essential Responsibilities:

• Identify and manage key reporting and analytic requirements across internal and external departments
• Establish and manage the data infrastructure necessary to support all PPO related reports.
• Lead development and interpretation of Tableau reports to monitor performance.
• Manage ASC, lab, and radiology redirection programs
• Analyze data to identify trends and opportunities.
• Validate internal reporting against health plan-provided reporting
• Provide guidance and recommendations to medical leadership through SMT collaboration, planning and provider education
• Support the evaluation and negotiation of new value-based payments arrangements and amendments proposed by health plans
• Maintain summaries of health plan ACO program terms and performance
• Coordinate and summarize cross-functional reviews by clinical, analytic, and operational teams of proposed terms, and model the summary financial impact of proposed contract terms
• Present program status, plans, and risks to internal and external executive and senior-level stakeholders
• Act as the single point of contact between health partners and our internal data and analytics teams to resolve data and operational issues with our health plan partners.
• Maintain an up-to-date library of documents and decisions related to our health plan relationships, inclusive of executed contracts and amendments, information on new programs, and annual metrics and reporting.
  
  
  

Skills and Experience Required:

• Education: Bachelor’s degree in business, health administration, information management, or related field.
• Work experience: 1-3 years of industry experience supporting complex projects with internal and external stakeholders including health plans, physicians and/or providers.
• Strong written, verbal and presentation communication skills
• Knowledge of relationship management, process improvement, and physician and member engagement.
• Software skills required: Word, Excel (pivot and lookup), PowerPoint, Tableau, and Salesforce
• Other skills:
• Passionate about the complexities of healthcare delivery networks and alternative payment arrangements
• Collaborates well with external clients and partners.
• Organized, able to handle multiple projects.
• Attends to detail without losing the bigger picture.
• Builds sustainable and collaborative cross-functional relationships.
• Able to identify potential problems in advance and propose solutions.
• Excited to continuously learn and grow.
  
  
  

Additional Information:

Salary: $85,000 - $110,000 Annual

Hill Physicians is an Equal Opportunity Employer