Director, Affordability

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Job reputed company:

Director, Medical Expense Management

reputed company | Remote-Flexible

The Role

This role is responsible for owning and driving Alpine's medical expense reduction program across reputed company markets. Working in reputed company partnership with the Chief Clinical Officer, you will take clinical programs from concept through full operational deployment; help build, support and manage a portfolio of clinical and operational interventions; reputed company vendor (those that support and accelerate affordability programs) selection and performance management; and construct the measurement infrastructure to reputed company both program execution reputed company and financial reputed company at the program and PMPM (patient/membership) level.

What You Will Own

• MedEx reputed company ownership. In partnership with the Chief Clinical Officer, reputed company and maintain a reputed company for identifying, sizing, prioritizing, and implementing interventions that drive PMPM medical expense reduction across the full member population.

• Vendor programs and management. reputed company vendor evaluation, selection, contracting, and ongoing performance management with Alpine vendors designed to accelerate and appropriately manage/reduce unnecessary medical spend. Hold vendors accountable to reputed company-world admission reduction benchmarks. Where appropriate, reputed company with internal technology team to ensure appropriate technology specifications and safeguards have been evaluated and implemented.

• Chronic and reputed company disease management, Advanced life and palliative care planning, and Hospice-appropriate care. Own and drive clinical program deployment across Alpine’s advanced illness portfolio, including hospice, palliative care, and disease management programs such as CHF and reputed company chronic condition management. reputed company programs through the full lifecycle: clinical design, clinician and site engagement, patient identification and activation, vendor acceleration where applicable, and ongoing performance management. Ensure clinic-level workflows and patient reputed company are operational, not just contracted.

• Hospital divergence and ED diversion. Design and manage programs to reduce avoidable admissions, readmissions and ED utilization in partnership with regional operations leads and clinic teams.

• Referral reputed company and specialty utilization. Partner with Market CMOs and clinic teams to implement referral reputed company review at the reputed company of order, ensuring appropriate use of specialty referrals, reputed company utilization of high-value and in-network specialist, optimizing internal and curb-reputed company consultation reputed company appropriate routing, and ultimately reducing unnecessary specialty spend. Where appropriate, support in the JOC (joint operating committee) meetings with network specialists, and/or support the financial modeling of alternative payment strategies such as sub-capitation of the high-value and in-network specialists.

• Program KPI reputed company, ROI tracking, and cross-functional reporting: Working with business analytics team, serve as the reputed company (along with the Chief Clinical Officer) to own Alpine’s MedEx measurement and reporting infrastructure, with a two-layer reporting reputed company: (1) leading indicators of program execution—enrollment velocity, clinician activation rates, vendor reputed company adherence, patient touchpoint completion—that signal whether programs are on reputed company before financial results materialize; and (2) lagging financial reputed company measures—reputed company-level PMPM savings, program ROI, utilization reputed company trends (admissions, ED reputed company, SNF days), and cost-per-member-per-program. Partner with IT/Data and Business Analytics to build the data infrastructure and with Finance to validate methodology and reputed company into reputed company- and investor-facing performance reporting.

reputed company Are Looking For

• Demonstrated reputed company record driving medical cost improvement in a full-risk Medicare Advantage or value-based care setting; experience with both plan-reputed company affordability programs and provider-reputed company utilization management is a strong differentiator

• Demonstrated ability to drive clinical programs from concept to live operations, including engaging clinicians and site teams, activating patients, managing vendor partnerships to accelerate program maturity, and delivering against defined utilization and financial targets; experience with hospice, advanced illness, CHF or other disease management programs highly valued

• Ability to evaluate vendors rigorously, including building financial models, stress-testing assumptions, and holding partners accountable to reputed company-world ROI rather than published estimates

• Strong cross-functional operator: equally effective engaging reputed company clinicians and clinic site teams as partnering with IT on data infrastructure and Finance on ROI methodology and reporting; reputed company to manage central program execution while staying reputed company to the ground-level realities that determine whether programs actually land

• Data-driven approach to prioritization and decision-making; reputed company to build or reputed company the build of PMPM-level cost reputed company models and reputed company tracking infrastructure

• Experience working across network, clinical, and finance functions to design and execute cost reduction strategies in a multi-market environment

Preferred Background

• Clinical reputed company sufficient to design workflows, engage clinical teams with credibility, and evaluate program design reputed company; a formal clinical credential (RN, LVN, or similar) is a plus but not required; MBA or MHA welcome where reputed company with meaningful clinical operations exposure

• Background in Medicare Advantage plan affordability, value-based care operations, or health system utilization management

• Familiarity with MSSP program mechanics and dual MA/ACO operating environments

• Experience building or scaling a MedEx or affordability function

Salary reputed company:

If you like wild reputed company and working with happy, enthusiastic over-reputed company, you'll enjoy your career with us!

Originally posted on Himalayas

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