Program & Contracting Specialist, Medicare ACO
Steward Health Care Network (SHCN) takes pride in its community-based care model, which drives value-added tools and services to our communities, patients, physicians, and hospitals across the continuum of care. In addition, Steward Health Care Network promotes care coordination and collaboration within the network in order to provide high-quality, efficient care to patients. With Steward in the community, all residents can be sure that there is a world class doctor close to where they live.
The network is also responsible for the implementation and execution of our managed care contracts, medical management services, quality improvement programs, data analysis, and information services.
Position Purpose: The position will support Steward's Medicare ACO programs (primarily, but not limited to, the Medicare Shared Savings Program) with the Centers for Medicare and Medicaid Services (CMS) in four key ways:
- Project manage ongoing and new operational initiatives that improve the quality of care for our Medicare population
- Lead the annual recruitment and contracting efforts of the Preferred Skilled Nursing Facility (SNF) network to drive performance to Medicare ACO programs
- Support program performance through execution of high-value initiatives derived from data-driven recommendations
- Monitor and ensure compliance with all applicable CMS regulations.
Seeking motivated professionals with work experience in the Medicare or healthcare field with a strong desire to learn, polished interpersonal skills, and an ability to use data analysis to drive decisions. Individuals who are organized and collaborate well with others will resonate with our team.
Project manages and assists the team in providing operational and analytic guidance for the Medicare ACO programs:
- 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
- Interfaces with departments across the organization (e.g. care management, analytics, compliance, information technology, legal, etc.)
- Works closely with analytics to evaluate, understand, and develop program recommendations based on data-driven ROI projections and cost-benefit-risk analyses to inform leadership of the appropriate direction.
- Assists with beneficiary engagement efforts to better educate providers and internal departments about the program 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.
Leads the Preferred SNF contracting efforts in close collaboration with SHCN’s care management department and executive team
- Meets with current and potential SNF partners to explain program requirements and expectations
- Responsible for disseminating contracts and collecting agreement signatures
- Provides organizational and analytical guidance to care management department and Medicare ACO team
- Works closely with multiple SHCN departments to understand and help resolve data or contract issues
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., changes to SNF reimbursement)
- Participates in weekly/monthly MSSP educational webinars and informs the team of his/her findings
- Evaluates how research and findings can be implemented with Steward’s programs
Education / Experience / Other Requirements
- Required – Bachelor's degree or equivalent education
- Preferred – MPH, MHA, MBA, or other Master's degree
Years of Experience:
- Experience working in a fast-paced, health care environment
- General knowledge of the health care industry including managed care organizations, hospital settings, and/or physician practices.
- Project management experience preferred
- Healthcare delivery (Medicare-related) experience preferred
- Proficiency with Excel is critical
- Skilled in PowerPoint, Word, and other programs
- Strong interpersonal skills and ability to interact positively with a wide range of constituents across several 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 timelines 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.
- 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.
Steward Health Care is an Equal Employment Opportunity (EEO) employer. Steward Health Care does not discriminate on the grounds of race, color, religion, sex, national origin, age, disability, veteran status, sexual orientation, gender identity and/or expression or any other non-job-related characteristic.