Senior, Program Specialist - 25-196

Hill Physicians Medical Group•San Ramon, CA

68d•$120,000 - $140,000

About The Position

This role is responsible for developing and growing our health plan relationships in support of our broader PPO 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 PPO initiatives internally and externally, as well evaluates and implements new programs.

Requirements

Bachelor's degree in business, health administration, information management, or related field.
5-7 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
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.

Responsibilities

Coordinate performance reporting and communications with our health plan partners and with senior leadership to ensure progression toward our clinical, financial, and operational goals for the PPO program.
Define the agenda and coordinate content across several departments for recurring external meetings and steering committees with each partner health plan.
Execute and delegate action items with our health plan partners across various Hill departments and meet 1:1 with health plans to ensure progress between committee meetings.
Summarize and present the PPO Program's recent achievements, performance, and challenges to senior leadership and health plan partners
Support the evaluation and negotiation of new value-based payments arrangements and amendments proposed by health plans
Review health plan contracts to understand each partner's unique ACO arrangement
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
Enhance current PPO initiatives and guide the development of new and existing interventions using health plan-provided data and reporting
Identify trends and opportunities using different reports from the health plan
Validate internal reporting against health plan-provided reporting
Provide guidance and recommendations to providers and medical leadership
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.