Senior, Program Specialist

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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.

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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.

DE&I Statement :

At PriMed, your uniqueness is valued, celebrated, encouraged, supported, and embraced. Whatever your relationship with Hill Physicians, we welcome ALL that you are.

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 PPO 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 PPO initiatives internally and externally, as well evaluates and implements new programs.

Essential Responsibilities :

• Coordinate performance reporting and communications with our health plan partners and with senior leadership to ensure progression toward our clinical, financial, and operational goals for the PPO program.
• Define the agenda and coordinate content across several departments for recurring external meetings and steering committees with each partner health plan.
• Execute and delegate action items with our health plan partners across various Hill departments and meet 1 : 1 with health plans to ensure progress between committee meetings.
• Summarize and present the PPO Program's recent achievements, performance, and challenges to senior leadership and health plan partners
• Support the evaluation and negotiation of new value-based payments arrangements and amendments proposed by health plans
• Review health plan contracts to understand each partner's unique ACO arrangement
• 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
• Enhance current PPO initiatives and guide the development of new and existing interventions using health plan-provided data and reporting
• Identify trends and opportunities using different reports from the health plan
• Validate internal reporting against health plan-provided reporting
• Provide guidance and recommendations to providers and medical leadership
• 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

Additional Information :

Salary : $120,000 - $140,000 Annual

Hill Physicians is an Equal Opportunity Employer