Manager of Government Programs
The Eastside Health Network has an outstanding opportunity for a Manager of Government Programs to join our team! The Manager of Government Programs promotes the success of Medicare Advantage contracts within Eastside Health Network (EHN) by providing leadership, strategy and oversight of communication, alignment, infrastructure and operational leadership related to Medicare initiatives. Specifically, in the pursuit to fulfill the quadruple aim, this role conducts and oversees ongoing educational outreach with a focus on improving quality and financial outcomes across EHN. Additionally, the Government Programs Manager acts as a conduit between EHN providers and the health plans to enhance the business relationship, improve efficiency and reduce the burden of providers within EHN. Finally, this role functions as the conduit between EHN and the hospital systems to ensure robust communication and alignment.
- Plan and integrate functions and services to support Eastside Health Network’s goals and priorities.
- Build effective working relationships across EHN, Overlake, and EvergreenHeatlh with managers, staff, physicians, customers and suppliers.
- Provide leadership for effective service:
- Select qualified and competent employees; provide orientation and continuing education and development.
- Communicate EHN’s vision and priorities and facilitate development of team and individual goals in alignment with organization goals.
- Establish performance expectations and provide coaching to achieve positive results. Recognize effective performance, and address performance needing improvement in an honest and timely manner.
- Empower staff to make decisions by providing information and tools.
- Serve as an effective role model of Overlake’s Shared Values and encourage staff to develop and demonstrate those values.
- Continually assess and improve care and services provided to meet or exceed the needs and expectations of customers. Foster continuous quality improvement by leading teams in use of quality management tools and processes.
- Manage organizational resources with fiscal responsibility and promote effective allocation and utilization.
- Facilitate the operational relationship between EHN and its contracted Medicare Advantage (MA) payors including:
- Function as primary communications conduit between EHN and MA payors
- Monitor requirements related to data exchange and annual updates to data specs, communicating updates to EHN’s Quality and Analytics Team
- Monitors quality and data analytics with supplemental data file spec communication
- Monitors the process of tracking and reporting key membership information
- Develops, leads and oversees the Medicare Risk Adjustment/Hierarchical Condition Categories capture process and works with payors and EHN providers to evaluate the tools and resources available
- Manage and direct EHN coding and documentation staff
- Responsible for ensuring PCP roster and membership alignment algorythms, ensuring accuracy of providers to patients assigned
- Coordinate and design the process of PCP departure and change support for members
- Documentation and distribution of required contracting elements to providers and practices
- Gather and assimilate provider contract and operational implementation feedback and work with MA payors to improve efficiency, cost, outcomes and satisfaction for providers and patients.
- Deliver education of MA requirements, flow of funds and plan mechanics to network providers
- Evaluation and coordination of payor reports, tools and programmatic resources
- Educate providers and staff on purpose, benefits, and billing guidelines of Medicare Annual Wellness Visits
- Medical record collection, Sweeps requests
- Resource for EHN provider coding and documentation champions
- Scheduling of Joint Operating Committee and coordination of participants, worklists and follow-up
- Work with EHN’s Quality and Analytics team and Care Management team to determine how EHN resources including the population health management tool and existing native EMR/EHR resources support payer initiatives
- Work with primary care clinics to help define operational approaches which can be defined to better support HEDIS, AWVs, coding and documentation, and patient engagement.
- Act as a liaison between the provider and the health plan ensuring a coordinated effort in improving financial and quality performance
- Membership and Open Enrollment Support:
- Creation and ownership of annual planning calendar for each MA plan
- lead strategy for patients who are turning 65
- Responsible for development and oversight of annual open enrollment strategy and responsibility for coordination of outreach and marketing to enrollees, including brokers.
- Coordinates work with EHN teams: Director of Care Management, Payor/Provider Relations, Manager of Quality and Data Analytics, Contracting Directors and Strategic Project Manager. Ensures EHN communications channels have current Medicare Advantage plan information and initiatives.
- Leadership Incentive Plan
- Free public transportation pass (ORCA orcacard.com)
- Competitive compensation package
- Generous PTO
- Medical, dental, vision
- 2 part retirement plan including matching
- Long term disability
- Flex spending
- Extended illness banked hours
- Free parking
- Employee Assistance program
- Professional development
Just a few of our employee perks
- Cell phone plan discounts
- Discounted Mariners and Sounders tickets
- Computer discounts
- Discounted lift tickets
- Discounted movie tickets
- Discounted gym memberships
- Free Seattle Art Museum passes
- And much more
- Bachelor’s degree is required.
- Minimum of three years of combined managed healthcare and provider reimbursement experience is required. Managed care experience with an Accountable Care Organization or Clinically Integrated Network is preferred. Coding and documentation experience required, Certified Professional Coder (CPC) or equlivant certification preferred.
- Minimum of three years prior supervisory/lead experience in clinical or health information management (HIM), coding and documentation or ambulatory experience required.
Overlake is committed to providing ready access to a highly trained and compassionate medical team, who are consistent and comprehensive in coordination of care for all patients. Our group practice champions superior quality-of-care, superior outcomes, a superior patient experience, and work-life balance. We believe exceptional patient care comes naturally when our employees feel respected, valued and cared for too. These high standards and high expectations will give us the ability to recruit and retain the best healthcare teams in the region.
Overlake Medical Center is an Equal Opportunity Employer