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

Join Our Team!

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.

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.

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

Passionate about the complexities of healthcare delivery networks and alternative payment arrangements

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

Hill Physicians is an Equal Opportunity Employer