Payor Optimization Program Manager

Payor Optimization Program Manager

When you join the growing BILH team, you're not just taking a job, you're making a difference in people's lives. Partner with the Executive Director, Payor Optimization to manage key divisional initiatives that support provider enrollment, network relations, and payor responsibilities. The Payor Optimization Program Manager will be responsible for managing projects, compiling and disseminating contracting updates, supporting payor communication when changes need to be communicated, and maintaining all divisional resources - including training needs. This will involve high levels of collaboration, integration, and communication across the Performance Network.

Essential Duties and Responsibilities including but not limited to:

• Implement and manage projects and performance improvements initiatives that support all payor optimization divisional teams
• Develop, maintain, and advance all divisional resources which includes training needs, team SharePoint and drives, BILHPN webpage for divisional functions, documentation needs with workflows, resources for BILHPN divisional customers, and health plan contact lists
• Coordinate various divisional training needs, including but not limited to, leading or facilitating trainings through team SME's with supportive documentation
• Compile and disseminate contract updates with collaboration from the BILHPN contracting team, including facilitation of internal communication
• Create processes and workflows to support program/project management lifecycle for the division
• Supports BILHPN payor optimization and contracting teams with communication needs
• Perform analyses related to payor operations division programs, including, but not limited to lessons learned, opportunity, or assessing current program
• Partner with the team to identify and investigate opportunities related to the payor optimization division
• Collaborate with local care units, business units, and provider organizations across the network to implement projects/programs and understand needs
• Evaluate and create action plans to optimize, refine, or integrate technological solutions/functionality, including AI, where applicable into the respective payor optimization programs
• Support and troubleshoot any issues related to payor optimization projects/programs, maintaining a risk and issue log for each project
• Contribute to reporting package design and dissemination for all data components related to payor optimization programs
• Facilitates discovery and continuous improvement discussions with applicable stakeholders to incorporate into projects and program(s) as necessary
• Develop and maintain connections with vendors, where applicable, and other organizations to incorporate necessary discoveries into planning and strategies
• Assists in the communication of initiatives within the payor optimization division to local leaders, administrators, support staff, and providers
• Build and maintain working relationships with internal teams, administrators, vendors, revenue cycle, payors, practice operations, and provider community to foster collaboration and partnership in driving meaningful change within payor operations divisional areas

Organizational Requirements:

• Maintain strict adherence to all BILH and BILHPN Policies. Maintain courteous and effective interactions with colleagues and providers and stake holders. Demonstrate an understanding of the job description, performance expectations, and competency assessment. Demonstrate a commitment toward meeting and exceeding the needs of our customers and consistently adheres to customer service standards. Participate in departmental and/or interdepartmental quality improvement activities. Participate in and successfully completes Mandatory Education. Perform all other duties as needed or directed to meet the needs of the department.

Minimum Qualifications:

• Education: A Bachelor's Degree in Healthcare Management, Administration, Public Health, Business Administration, or other related functional area is required. A Master's Degree in healthcare or business-related field is preferred.
• Licensure, Certification & Registration: N/A
• Experience: Minimum 3-5 years of program or project management, system implementation, or clinical operations experience in a healthcare setting required.
• Understanding of project management and process improvement strategies
• Strong organizational skills and the ability to articulate complex workflows and processes
• Experience with navigating complex programs and projects
• Ability to work with data analysts and communicate needs
• Excellent communication skills, both written and verbal
• Understanding of value based care
• Skills, Knowledge & Abilities: Microsoft Word, Excel, Powerpoint, SmartSheet (preferred)

Key Relationships:

• BILHPN Ops Teams
• BILHPN Clinical Excellence Teams
• Local Care Unit Leaders
• Vendor Contacts (as applicable)
• Practice/Local Care Unit Staff
• Providers
• HMFP Leaders
• BILH Revenue Cycle
• APG Leaders
• BILHPC Leaders
• Care Retention & Access Leaders

Scope/Impact Statement:

Work Schedule: Indicate either Yes or No as appropriate. Hours of work may be subject to change based upon the needs of the business/department.

On Call: No Shift Rotation: No Weekends: No

Physical Requirements & Environment: Required

For each category, select ONE option from choices below by placing an X in the space to the left of the entry.

Mental and Visual Attention Required

a) The position requires basic mental and visual attention much or all of the time

b) The position requires periods of concentrated mental and visual attention.

c) The position requires a high degree of mental and visual concentration.

Physical Exertion

Weight

d) The nature of work requires lifting or moving light weight (up to 20 pounds).

e) Nature of work requires lifting or moving medium weight (over 20 and up to 75 pounds).

f) Nature of work requires lifting or moving heavy weight (over 75 pounds).

Dexterity

g) The flow of work and character of duties require average manual coordination.

h) Flow of work and character of duties require above average manual coordination.

i) Flow of work and character of duties require high manual coordination.

Range of Motion

j) Duties require average range of motion.

k) Duties require above average range of motion.

l) Duties require high range of motion.

Physical Conditions

m) Performance of duties allows for variation in positioning and tasks.

n) Performance of duties requires remaining in position for prolonged periods of time.

Repetitive Motion

o) Assignments require occasional repetitive motion.

p) Assignments require frequent repetitive motion.

q) Assignments require constant repetitive motion.

Working Conditions

r) Working conditions include minimal exposure to elements such as odor, noise, dust, chemicals, temperature extremes or airborne pathogens.

s) Working conditions include occasional exposure to elements such as odor, noise, dust, chemicals, temperature extremes or airborne pathogens.

t) Working conditions include continuous exposure to elements such as odor, noise, dust, chemicals, temperature extremes or airborne pathogens.

Exposure to Hazardous Materials

u) Performance of duties generally does not involve exposure to hazardous materials.

v) Performance of duties occasionally involves exposure to hazardous materials.

w) Performance of duties frequently involves exposure to hazardous materials.

Patient Care Conditions (select ALL that are applicable)

x) Position entails exposure to blood and body fluids, standard precautions must be used.

y) Assignments include transporting, transfer and positioning of patients.

z) Incumbent must be continuously prepared to prevent a patient fall.

Sensory Requirements (select ALL that are applicable)

aa) Performance of duties requires the ability to discern and identify colors

bb) Performance of duties requires the ability to discern sharp from dull and hot from cold

cc) Performance of duties requires the ability to hear soft and loud noises

Patient Care/Patient Contact Designation (check only one of the items listed below)

_ Position has a direct impact upon health outcomes of the patient.

_ Position facilitates the process that may impact patient access to services.

X No patient care/contact, and does