Senior Director of Managed Care

hace 4 días


Santiago, Metropolitana, Chile Hill Physicians Medical Group, PriMed Management A tiempo completo
About the Position
Hill Physicians Medical Group, PriMed Management is seeking a highly experienced professional to lead the Government Programs operations and manage the Full Risk business. As a key member of the organization, you will be responsible for developing and implementing comprehensive strategies to meet evolving market demands and position the company for growth while ensuring compliance with all federal and state regulations. The successful candidate will have significant experience in managed care operations, Medicare/MediCal/ACA programs, and full risk business management.

Select Responsibilities
  • Oversee the financial performance of the Medicare Advantage, MediCal, and Affordable Care Act (ACA) programs including risk adjustment/coding accuracy, provider incentive program, and vendor management.
  • Lead cross-functional teams in a matrixed organization, fostering collaboration among departments such as clinical management, utilization management, quality management, and financial analysis to achieve corporate goals.
  • Build and maintain robust relationships with health plan executives, internal stakeholders, and external partners to enhance collaboration, data exchange, and performance improvement strategies.
  • Direct the day-to-day operations of the Full Risk and Government Programs teams, ensuring all deliverables are met while coordinating necessary activities to support the organization's strategic goals.

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