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Corporate Functions & Operations WellCare - Operations Management Careers

Manager - ACO Implementation-UA Job

Full Job Title: Mgr, ACO Implementation-UA

Job Number: 1706064

Location: Houston, TX

Date Posted: 2-3-2018

This position directs and participates in ongoing operations, ad-hoc and special projects in four primary areas of broad responsibility for Collaborative Health Systems' Accountable Care Organizations (CHS ACOs): CHS ACO Operations, CHS ACO and Organization Information Technology Project Management Office (as co-leader), serve as subject matter expert analyzing operational, quality and financial data to provide ad-hoc guidance on strategic initiatives to the Vice President of Eastern Markets and operational lead for national and regional contracting of vendor partners supporting the strategic vision and activities of the ACOs.

Essential Functions:
  • Establish and maintain professional, effective and collaborative relationships to ensure that internal staff and external ACO partners to accomplish the ACO's mission.
  • Direct and oversee processes and technical infrastructure to facilitate information transfers among CMS, CHS staff and ACOs. Direct team that assures data accuracy and integrity in PBAS.
  • Liaison between business stakeholders and information technology staff: translate business requirements to convey specifications for system enhancements to developers and quality assurance testing teams. Participate in or coordinate end-user testing as needed.
  • Direct continual improvement of internal technical operations resources, including development of new tools and processes. Prioritize and manage ACO projects requiring information systems development or ACO data extracts for external stakeholders and vendors
  • Manage and improve externally-facing data communications processes, such as managing providers and ACOs in the Health Professional Management System (HPMS)
  • Participate in cross-functional reviews of and updates to ACO policies, procedures and standards and document operational processes and infrastructure changes in progress, via policies/procedures and business requirements documents and other tools
  • Lead implementation and integration efforts for Next Generation ACOs, including collaboration with Vice Presidents, General Counsel, corporate staff, Executive Director and market staff to ensure timely completion of regulatory, legal, infrastructure and business operations requirements to launch and maintain the ACOs. Ensure that governance model is appropriate.
  • Perform analysis and develop presentations for CHS corporate and market staff, ACO partners/physicians and vendor-partners
  • Primary interface with Corporate Compliance function to assure compliance with all guidelines established by CMS, other regulatory agencies, and defined in the corporate and department policies
  • Identify, vet and negotiate with ancillary providers at national, regional and local levels for ACO partnerships. Participate in strategic contracting initiatives at national, regional and local ACO market levels.
  • Develop, write and implement procedures and other materials and provide market staff training in Operations processes to ensure successful collaboration with contracted vendors
  • Manage infrastructure arrangements to operationalize new ACOs as well as establish and maintain infrastructure for exchange of data for approved vendors with Business Associate Agreements and Data Use Agreement Addenda through collaboration with Information Technology, Analytics and third-party software vendors
  • Content Administrator for CHS ACO, Project Management Office, Regions and Business Development SharePoint sites. Manages user access to SharePoint tools: review, approve and modify requests for user access as appropriate
  • Participate in development and evolution of educational materials and programs including implementation materials including but not limited to critical activity dashboards, provider/beneficiaries communications, templates for presentations to ACO governing bodies, and other materials as determined by individual market needs.
  • Direct team that processes, routes and archives incoming centralized mail. Approves workflows to establish network and application access for new staff and changes to privileges for current staff.
  • Comply with all guidelines established by the Centers for Medicare and Medicaid (CMS) and guidelines set forth by other regulatory agencies, where applicable, and defined in the CHS and department policies.
  • And all other duties assigned by the manager and/or supervisor.
Additional Responsibilities:
  • Support ACO and corporate staff with annual ACO Quality data collection and remuneration to ACO Participants.
Candidate Education:
  • Required A Bachelor's Degree in Business, Health Management, Information Systems, or related field or equivalent
  • Preferred A Master's Degree in a related field
Candidate Experience:
  • Required 5 years of experience in Experience with a major health plan and/or medical practice with Medicare/Medicaid exposure required, with Accountable Care Organization experience strongly preferred
  • Required 5 years of experience in Managing the strategy, implementation, and optimization of systems, software and process management tools
  • Preferred 5 years of experience in Writing provider-facing (e.g., physician, hospital, etc.) communications and provider relations encounters
  • Preferred 5 years of experience in Analyzing market rates, quality and claims payment methodology to draft agreements and negotiate payment structures, rates and incentives.
Candidate Skills:
  • Advanced Ability to work in a matrixed environment
  • Advanced Ability to drive multiple projects
  • Advanced Demonstrated interpersonal/verbal communication skills
  • Intermediate Ability to influence internal and external constituents
  • Intermediate Ability to analyze information and covert related activities into a comprehensive work plan
  • Intermediate Ability to multi-task
  • Intermediate Other Ability to produce work that is highly accurate, demonstrates attention to detail and reflects well on the organization
Licenses and Certifications:
A license in one of the following is required:
  • Preferred Project Management Professional (PMP)
Technical Skills:
  • Required Intermediate Microsoft Excel
  • Required Intermediate Microsoft Outlook
  • Required Intermediate Microsoft PowerPoint
  • Required Intermediate Microsoft Project
  • Required Intermediate Microsoft Visio
  • Required Intermediate Microsoft Word
  • Required Intermediate Microsoft Access
  • Required Intermediate Adobe Acrobate
  • Required Intermediate Other Microsoft SharePoint Content Admin

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Last Updated On: 12/9/2015