Network Planning Manager jobs in West Virginia

The Operations Planning Director will be primarily responsible for operational needs across the West Virginia Health Network and Managed Care Operations across the network and system.

Responsibilities

• Demonstrates leadership by planning and overseeing multiple, inter-related, complex, operational projects. • Responsible for the implementation and rollout of the policy and contractual requirements for the MSSP ACO, and other value based payer contracts. • Manages and coordinates activities across WVHN operational teams, steering workgroups and stakeholders. • Leads vendor contract negotiations, external partnership and management activities. • Presents findings and recommendations for action to WVHN leadership meetings including Board Meetings • ACO program oversight with CMS • Responsible for the website management for the WVHN • Responsible for the oversight of the quarterly managed care Joint Operating Committees. • Serve as key internal point of contact for issue escalations and resolutions from members and providers. Work with regulators as needed to solve problems as they occur. • Responsible for ensuring WVHN provider quality incentives are reported and distributed timely • Responsible for WVHN provider roster reconciliation and reporting changes to the managed care payers and CMS. • Responsible for the organization and oversight of the Managed Care payer contracts and value based documents. • Monitors, interprets and reports on changes in performance, market trends, health care delivery systems and legislative initiatives which impact program efforts (e.g., CMS ACO regs,) • Proactively assists in the development and implementation of Medicare compliance and privacy programs • Facilitates and operationalizes relationships with external organizations including federal Medicare divisions (CMS and CMMI) and community strategic partners. • Interface with regulators to participate in and report back on program meetings, track and obtain responses on program questions, etc. • Oversees the analysis of quality, utilization performance by provider, practice, region, payer and in the aggregate in order to inform contract performance and to identify whether improvement efforts have impacted performance. • Oversees the building, development and maintenance of data models, data automation, dashboards and performance metrics that support payer contract performance opportunities. • Oversees the receipt and processing of network performance, membership, utilization, and quality reports. • Ensure accuracy of data and deliverables of employees with comprehensive standards and processes. • Assist with contract storage, research, and analysis for the health system. • Track and maintain all correspondence escalated payer issues on behalf of the health system in support of Managed Care leaders. • Support health system leadership with special projects and assignments such as quarterly regulatory submissions that drive reimbursement REQUIRED KNOWLEDGE & SKILLS: • Experience leading change and driving growth across a business unit with P&L accountability. • Strong interpersonal skills and ability to interact positively with a wide range of constituents. • Ability to work both independently and within a team environment and a multi-dimensional environment. Creative, flexible, self-motivated, professional must possess sound judgment ability to plan and initiate new activities consistent with achieving service excellence. • Proven excellent written and verbal communication skills. Ability to present information to small and, at times, large audiences. • Strong organizational and project management skills including development of project parameters, goals, and timelines and outcome measurement. • Established passion for working towards improving the health of populations. • Analytic skills to collect information from diverse sources and summarize the information and data in order to solve problems. • Ability to function effectively within an ever-changing environment and to meet deadlines and reprioritize as necessary. • Must be able to maintain confidentiality of information. • Proficiency in Excel, Word, PowerPoint, Microsoft Project, and Access.

Knowledge, Skills & Abilities

Patient Group Knowledge (Only applies to positions with direct patient contact) The employee must possess/obtain (by the end of the orientation period) and demonstrate the knowledge and skills necessary to provide developmentally appropriate assessment, treatment or care as defined by the department’s identified patient ages. Specifically the employee must be able to demonstrate competency in: 1) ability to obtain and interpret information in terms of patient needs; 2) knowledge of growth and development; and 3) understanding of the range of treatment needed by the patients. Competency Statement Must demonstrate competency through an initial orientation and ongoing competency validation to independently perform tasks and additional duties as specified in the job description and the unit/department specific competency checklist. Common Duties and Responsibilities (Essential duties common to all positions) 1. Maintain and document all applicable required education. 2. Demonstrate positive customer service and co-worker relations. 3. Comply with the company's attendance policy. 4. Participate in the continuous, quality improvement activities of the department and institution. 5. Perform work in a cost effective manner. 6. Perform work in accordance with all departmental pay practices and scheduling policies, including but not limited to, overtime, various shift work, and on-call situations. 7. Perform work in alignment with the overall mission and strategic plan of the organization. 8. Follow organizational and departmental policies and procedures, as applicable. 9. Perform related duties as assigned.

Education

• Bachelor's Degree (Required) Education: business, accounting, or finance Experience: 5 years related financial experience. Substitution: May substitute 10 years relevant experience for the Bachelor's degree.

Credentials

Work Schedule: Days

Status: Full Time Regular 1.0

Location: Northgate-400 Association Dr.

Location of Job: US:WV:Charleston

Talent Acquisition Specialist: Anita J. Ferguson anita.ferguson@vandaliahealth.org