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Sr. Director of Healthcare Networks

UNITE HERE HEALTH

This is a Full-time position in Las Vegas, NV posted March 4, 2021.

Sr. Director of Healthcare Networks in Las Vegas, Nevada | Careers at Culinary Health Fund Please Enable Cookies to Continue Please enable cookies in your browser to experience all the personalized features of this site, including the ability to apply for a job. Welcome page Welcome page Returning Candidate? Log back in!

Sr. Director of Healthcare Networks

Job Locations US-NV-Las Vegas Posted Date 2 weeks ago (1/15/2021 3:53 PM) ID 2021-1651 # of Openings 1 Category Healthcare Delivery Company Culinary Health Fund

Overview

Our mission-driven organization is focused on the “Triple Aim” – Better Health, Better Healthcare and Lower Costs to individuals and their families who participate in our health plans.

The Culinary Health Fund serves over 100,000+ workers and 220,000 covered lives in the hospitality and gaming industry. Our desire to be innovative and progressive drives us to develop impactful programs and benefits designed to engage our participants in managing their own health and healthcare. Our vision is exciting and challenging. Please read on to learn more about this great opportunity!

Key Attributes:

  • Integrity – Must be trustworthy and principled when faced with complex situations

  • Ability to build positive work relationships – Mutual trust and respect will be essential to the collaborative relationships required

  • Communication – Ability to generate concise, compelling, objective and data-driven reports

  • Teamwork – Working well with others is required in the Fund’s collaborative environment

  • Diversity – Must be capable of working in a culturally diverse environment

  • Continuous Learning – Must be open to learning and skill development. As the Fund’s needs evolve, must be proactive about developing new areas of expertise

  • Lives our values – Must be a role model for the Fund’s BETTER Culture and Mission (Better, Engage, Teamwork, Trust, Empower, Respect)

Responsibilities

The purpose of this position is to provide strategic and operational leadership to the Las Vegas Fund staff, Trustees, medical directors, network providers and vendors in the delivery of healthcare programs and services. Responsibilities include management of provider network (physician, ancillary and hospitals), and oversight and management of all contracted vendors, including multi-million dollar pharmacy benefit manager, third party administrator, behavioral health, dental, management of consultants and capitated relationships. This position leads the strategic development and implementation of reimbursement methodologies, disease management, shared risk contracting and physician behavior modification programs. 

This position, through measurement and management of medical utilization and cost per medical service, is responsible for the management of the overall medical and pharmacy trend. 

ESSENTIAL JOB FUNCTIONS AND DUTIES

  • Knowledge of all capitated contracts; ongoing monitoring of contract terms to ensure compliance and/or obtain corrective action plan
  • Collaboration with Aurora staff to enhance services and ideas
  • Skills to develop and maintain strong partnerships
  • Provide clinical oversight of Hospital quality programs with Health Services Coalition
  • Provide direction and management oversight to assigned functions in the areas of budgets, operations, and staffing (selection, performance evaluation, coaching & development, etc.)
  • Foster and manage relevant Las Vegas-based vendor/provider relationships and their individual contractual, delivery of service, quality, and total costs
  • Lead all activities related to management of healthcare delivery programs, e.g., wellness, pharmacy, specialty programs, etc.
  • Negotiate service provider (physician, ancillary, hospital) contract language and reimbursement structure in line with legal and regulatory requirements, Fund specifications and objectives, and in collaboration with legal counsel
  • Lead activities related to Trustee recommendation/justification for selection, renewal or termination of benefit service providers
  • Clinical program management – Strategic management and development of: wellness, maternity management, quality assurance, spine, and diabetes programs, etc.
  • Identify Plan trends and issues as well as corresponding solutions designed to address/resolve
  • Participate in collaborative development and implementation of strategy to address health care market issues facing the Las Vegas Plan Unit
  • Ensure Fund compliance with Federal mandates related to healthcare delivery systems/programs
  • Lead RFP/RFI process, as applicable
  • Oversee monitoring and evaluation of service providers (physician, ancillary, hospital)
  • Lead related activities associated with new business development
  • Develop, implement and monitor Fund policies regarding provider performance standards, review and evaluation procedures, fraudulent and/or abusive behavior by providers and/or participants
  • Plans, analyzes, and evaluates programs and services, operational needs, and fiscal constraints
  • Supervises, leads, and delegates work and coaches, mentors, develops employees
  • Analyzes problems, identifies and develops alternative solutions, projects consequences of proposed actions, and implements recommendation/solutions
  • Recommends hires and promotions, directs and evaluates employment decisions for all assigned positions
  • Assists with developing and coordinating policies and procedures
  • Responsible for the oversight of continued employee training requirements, safety and quality initiatives
  • Performs other duties as assigned within the scope of responsibilities and requirements of the job
  • Performs Essential Job Functions and Duties with or without reasonable accommodation

Qualifications

Years of Experience and Knowledge

  • Knowledge of Credentialing concepts and principles
  • Understanding of Healthcare community in Las Vegas Valley
  • 7 ~ 10 years of related experience minimum
  • 3 ~ 5 years of team management experience required
  • Relevant experience with a Taft-Hartley Fund, insurance carrier or other third-party benefits payor as well as familiarity with the operations of welfare fund employee benefit plans
  • Strong understanding of health care trends and statistical measures of healthcare performance
  • In-depth understanding of utilization review, disease and demand management, provider contracting, physician profiling, pharmacy and therapeutic programs, outcomes measurement, and performance improvement
  • Strong understanding of current benefits legislation, e.g., ERISA, DOL, IRS, COBRA, HIPAA, etc.

Education, Licenses, and Certifications

  • Bachelor’s degree in Healthcare Administration, Business Administration, Nursing or related field or equivalent work experience required
  • Preferred: Master’s degree in related field
  • Preferred: Nevada Licensed Registered Nurse

Skills and Abilities

  • Minimum level computer skills in a Microsoft Office environment: Intermediate
  • Bi- or Multi- lingual skills (written and verbal): A Plus
  • Professional communication and presentation skills
  • Project management skills
  • Collaborative relationship building and interpersonal skills
  • Ability to:
  • Demonstrate leadership qualities that reflect the Fund’s mission, vision and values
  • Demonstrate flexibility and maturity, including a demonstrated ability to successfully manage complex situations in an environment that experiences rapid growth and change
  • Demonstrate strong track record in improvement of health care value for health benefits plan participants and sponsors
  • Evaluate, analyze and provide feedback regarding leadership initiatives
  • Communicate effectively with leaders who have less technical background and less time for detail
  • Deliver presentations in a professional and effective manner to a variety of audiences
  • Manage competing deadlines and multiple projects in a fast-paced environment
  • Communicate effectively with Medical Community

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