RN Registered Nurse Senior Manager Population Health

Position Summary

This position facilitates programs related to medical management, performance-based arrangements, and managed care programs. Interfaces with all levels of staff, health plans and physicians. Develops processes and implementation activities required to launch payer projects. Coordinates across all levels of the organization to implement solutions.

Core Functions

• Serves as a program facilitator for value based arrangement.
• Facilitation includes the development of implementation schedules, procedures and programs as well as implement and maintain the payer products including related goals and objectives.
• Ensures compliance with federal and state regulations, as well as established organizational policies and procedures.
• Participates in the development and implementation of select payer programs, short and long-range goals and objectives and determines the optimal progression to obtain these goals.
• Reviews analyses and reports of various activities to determine progress toward goals and objectives.
• Reviews, prepares, analyzes, and presents reports and recommendations to senior management to provide concise and accurate information that aids in decision-making.
• Develops, reviews, and monitors financial outcomes using performance metrics.
• Acts as Liaison between assigned payer and the business.
• Maintains a current professional and technical knowledge relating CMS and payer requirements and directives for Risk Adjustment and Quality to ensure policies and procedures meet compliance requirements.

Minimum Qualifications

• Must possess a strong knowledge of business and/or healthcare as normally obtained through the completion of a bachelor’s degree in business, healthcare administration or related field.
• Current license as a Registered Nurse.
• Proficiency typically achieved with five or more years of RN experience in health care or managed care related field.
• Requires proven record of leading meetings, presenting to groups, ability to build consensus and implement advanced business solutions.
• Requires thorough familiarity with workflow and process improvement applicable to a healthcare setting, along with prior project management experience.
• Must possess strong oral, written and interpersonal communication skills to effectively interact with all levels in the organization.
• Absolutely must have skills to mentor and educate clinical and non-clinical teams to transform health care to a population health model.
• Requires sound clinical judgment and an understanding of risk adjustment and managed care concepts.