DaVita Manager, Health Plan Analysis in EL SEGUNDO, California

Manager, Health Plan Analysis

Description

DaVitaMedical Group manages and operates medical groups and affiliated physiciannetworks in California, Nevada, New Mexico, Florida, Colorado and Washington inits pursuit to deliver excellent-quality health care in a dignified andcompassionate manner. As of June 30, 2016 DaVita Medical Group (formerlyHealthCare Partners) provided integrated care management for approximately760,000 patients. DaVita Medical Group’s leadership development initiatives andsocial responsibility efforts have been recognized by Fortune, ModernHealthcare, Newsweek and WorldBlu.

Weare committed to bringing the benefits of coordinated care to our patients andto taking a leading role in the transformation of the national healthcaredelivery system to assure quality, access, and affordable care for all.

Ifyou're looking to make a difference with a large, financially stable,well-recognized medical group, DaVita Medical Group may be the employer foryou.

Overview:

Responsible for health plan compliance to financial terms including the analysis, audit and reporting of health plan performance, and the development of systems to monitor expenses.

Essential Functions:

  • Consistently exhibits behavior and communication skills that demonstrate HealthCare Partners’ (HCP) commitment to superior customer service, including quality, care and concern with each and every internal and external customer.

  • Maintains a solid working knowledge of all health plan contracts and their assignment to various client entities.

  • Directs the development of effective controls to monitor health plan financial performance and assures adherence to all contract financial provisions.

  • Serves as a liaison with health plan representatives regarding implementation of contract financial terms.

  • Directs the development of models to predict health plan performance.

  • Oversees health plan reporting including enrollment, capitation, pharmacy, hospital fund and other factors.

  • Develops additional health plan reporting as dictated by current needs of client organizations.

  • Ensures accuracy of information provided by the department.

  • Ensures supportability of health plan revenue accruals and consistency to GL entries.

  • Oversees the analysis of health plan performance by product line to provide benchmarks.

  • Recommends revenue enhancement and cost reduction strategies in relation to health plan management and contracting.

  • Develops models and systems that assure parity in allocations among the various entities. Oversees all reinsurance and stop loss policies. Develops procedures that maximize recovery under such policies.

  • Develops audit procedures and systems for health plan capitation and hospital fund activities that identify discrepancies and maximize recovery.

  • Develops departmental and individual goals.

  • Maintains a departmental structure that is conducive to productivity and quality.

  • Assures that staff has the information and tools necessary to perform their functions including notification of all contract changes.

  • Develops, monitors and reports departmental budget.

  • Uses, protects, and discloses HCP patients’ protected health information (PHI) only in accordance with Health Insurance Portability and Accountability Act (HIPAA) standards.

  • Performs additional duties as assigned.

Qualifications

EDUCATION:

  • Bachelor’s degree from a four-year college and/or a professional certification requiring formal education beyond a two-year college.

  • Master’s degree preferred.

EXPERIENCE:

Minimum:

  • Over 3 years and up to and including 5 years of healthcare experience.

  • Supervisory experience.

Preferred:

  • 2 or more years experience in a managed healthcare organization.

  • 4 or more years of analytical, financial and/or accounting experience (2 years of which are substitutable by a graduate degree).

KNOWLEDGE, SKILLS, ABILITIES:

  • Computer literate.

  • Proficient in Microsoft Office applications (Word, Excel, Access).

  • Excellent verbal and written communication skills.

Primary Location CA-EL SEGUNDO - 90245

Req ID: 307526