Health System Senior Director, Managed Care

NYU Langone Health is a fully integrated health system that consistently achieves the best patient outcomes through a rigorous focus on quality that has resulted in some of the lowest mortality rates in the nation. Vizient Inc. has ranked NYU Langone the No. 1 comprehensive academic medical center in the country for three years in a row, and U.S. News & World Report recently placed nine of its clinical specialties among the top five in the nation. NYU Langone offers a comprehensive range of medical services with one high standard of care across 6 inpatient locations, its Perlmutter Cancer Center, and over 320 outpatient locations in the New York area and Florida. With $14.2 billion in revenue this year, the system also includes two tuition-free medical schools, in Manhattan and on Long Island, and a vast research enterprise with over $1 billion in active awards from the National Institutes of Health.

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Position Summary:
We have an exciting opportunity to join our team as a Health System Senior Director, Managed Care.

In this role, the successful candidate in the position will support all population health and value-based analytics required by Managed Care Payment Reform, NYUPN Clinically-Integrated Network, NYU Langone, IPA, and Network Integration, as well as reporting and analytics required by Faculty Group Practice (FGP) Managed Care. The position will intake, synthesize, and interpret complex datasets to communicate recommendations to senior management. The position will directly interact with population health vendors on development, build, and enhancement to meet clinical and business needs. The position will also interface and provide analytic support and expertise to the Delivery System Reform Incentive Payment (DSRIP) team.Value-based and population health analytics will be the primary focus of this position. This position will work closely with clinicians, senior management, finance, Network Integration, Faculty Group Practice, and Managed Care to develop and enhance a strategy that will assist NYU Langone in dealing with the new payment reforms that stem from Federal legislation and other market forces. The position will lead the development of operational reporting and dashboards to track and measure performance of care coordination, pharmacy, and quality care team interventions. A solid understanding of the future changes that will impact the health care delivery and payment systems is essential to assist the organization in developing and strengthening care competences and to position it for ongoing success. In this role, the incumbent will direct the development and implementation of accurate, timely analyses required to predict and prepare for the effects of payment reforms on NYU Langone in preparation for, during, and after payment reforms take effect. This position will be responsible for developing and implementing analytics, goals, and strategies for the successful completion of internal payment reform and value-based pilots and initiatives. Additionally, the incumbent will lead and direct efforts for the completion of Federal, State, or local applications required to participate in payment reform demonstration projects and programs. Examples of alternative payment systems are bundled/episode of care payments, gain sharing arrangements, value-based purchasing incentive payments, pay for performance arrangements, readmission rate reduction payments, patient-centered medical home incentive payments, and accountable care shared savings arrangements.
In this role, the incumbent will be responsible for analyzing data sets across the organization and between care providers from various treatment settings to determine the costs and clinical components associated with episodes of care and value-based payment. An episode may include several levels and types of care providers and may cross a number of venues including physician offices, hospital inpatient and outpatient settings, inpatient rehabilitation, skilled nursing facilities, home health services, and others. This position will directly interact with each of these care providers to outline current care practices, highlight opportunities for improvement, inform all parties of best practices for medical management, and assist in constructing a patient-centered future state process flow and shared clinical pathways. In collaboration with senior management, finance, quality, network integration, and managed care, this position will be responsible for developing a scorecard of financial and quality indicators to manage payment reform projects and negotiate contractual, and possible gainsharing, arrangements with all care providers affiliated with the projects.

Job Responsibilities:

• Direct the development and implementation of accurate, timely analyses required to predict and prepare for the effects of payment reforms on NYU Langone in preparation for, during, and after payment reforms take effect.
• Synthesize complex information to communicate project deliverables and recommendations to senior management
• Exercise discretion and independent judgment in comparing and evaluating options and approaches to analyses, including possible courses of conduct
• Provide analytics support to the SVP and Chief of Managed Care and the Executive Director, NYUPN
• Prepare and deliver presentations to executive committees and value-based project teams
• Serve as a subject matter expert within the organization who is sought out by others for advice and solutions relevant to analytics and reporting areas of expertise
• Manage staff members on projects while serving as a project lead
• Provide analytics leadership for select performance improvement and care management initiatives
• Provide consultation to senior management on FGP Managed Cares analytics and reporting requirements and the tools needed to address requirements
• Work with FGP and Managed Care leadership to understand business data needs, and to develop analytics and reporting to meet those needs
• Intake and analyze data extracts from Experian contract manager to manage reporting on claims payments, including over and underpayments
• Manage analytics and reporting for the Faculty Group Practice (FGP) Managed Care team
• Remain knowledgeable on HEDIS, STARS, NCQA, CMS and other national quality changes and measure definitions to inform Network Integration reporting requirements
• Work directly with population health analytics vendors on development and build of their tools to meet business requirements
• Assess population health analytics tools from vendors such as Optum and Epic Healthy Planet, and provide recommendations to senior management on limitations, challenges, and successes of such platforms
• Facilitate the development, maintenance and enhancement of online visualizations and dashboards to provide reliable, actionable, and transparent information
• Develop applicable process and outcome metrics to measure project and clinical intervention success.
• Develop performance, impact, and productivity reporting for Network Integration clinical interventions
• Lead the reporting activities for quality of care, care coordination, and pharmacy teams in Network Integration
• Direct analytics for the Network Integration Department and serve as team lead of the Network Integration analytics team as well as the Managed Care Payment Reform analytics team
• Collaborate with senior management, finance, quality, and managed care to develop a scorecard of financial and quality indicators to manage payment reform projects and negotiate contractual, and possible gainsharing, arrangements with all care providers affiliated with the projects.
• Directly interact with various care providers to outline current care practices, highlight opportunities for improvement, inform all parties of best practices for medical management, and assist in constructing a patient-centered future state process flow and shared clinical pathways across an episode of care.
• Lead and direct efforts for the completion of Federal, State, or local applications required to participate in payment reform demonstration projects and programs.
• Develop and implement objectives, goals, and strategies for the successful completion of internal payment reform pilots and initiatives.
• Responsible for analyzing data sets across the organization and between care providers from various treatment settings to determine the costs and clinical components associated with episodes of care and value-based activities.

Minimum Qualifications:
To qualify you must have a Masters degree in Health Care or Public Health. Ten years of progressive health care experience with 8 years experience in statistical analysis, research and/or healthcare reporting.
- The candidate must have strong leadership, communication, interpersonal, organizational, people management, analytical, customer service, teamwork, and problem-solving skills.
- Candidates must be action-oriented, with experience managing aggressive deadlines, strong technical proficiencies (e.g., highly proficient in Microsoft Word, Excel, PowerPoint, Tableau).
- Ability to exercise discretion, independent judgment, and critical thinking in selecting the optimal course of action.
- Experience managing small to mid-sized teams.
- Experience working with population health vendors and assessing and evaluating vendor products
- Experience providing analytic insights/direction and facilitation to aid in the development of value-based programs, strategies and platforms for existing and potential initiatives
- 8 years health care analytics experience
- Experience with visualization reporting tools is required.
- Ability to work in unstructured environments and to multi-task
- Effective organizational/analytical skills and the ability to effectively communicate with individuals across all levels of the organization are required
- Excellent communication skills both written and verbal
- Knowledge of hospital and physicians claims data sets
- Ability to chair meetings and coordinate work among various parties
- Knowledge of Federal and State policies and procedures
- Ability to perform statistical analysis using data analysis software (e.g. Excel, Access, SPSS, SAS, etc.)
- Ability to interpret the results of data analysis processes and draw conclusions from statistical results
- Ability to write results of statistical analysis in a public-friendly language
- Ability to create tables and graphs to present statistical results in visual form
- Knowledge of healthcare-related publications
- Knowledge of organizations conducting research in healthcare reporting (e.g. Leapfrog, NCQA, etc.)
- Ability to read and draw conclusions from research reports

Qualified candidates must be able to effectively communicate with all levels of the organization.

NYU Langone Health provides its staff with far more than just a place to work. Rather, we are an institution you can be proud of, an institution where you'll feel good about devoting your time and your talents.

At NYU Langone Health, we are committed to supporting our workforce and their loved ones with a comprehensive benefits and wellness package. Our offerings provide a robust support system for any stage of life, whether it's developing your career, starting a family, or saving for retirement. The support employees receive goes beyond a standard benefit offering, where employees have access to financial security benefits, a generous time-off program and employee resources groups for peer support. Additionally, all employees have access to our holistic employee wellness program, which focuses on seven key areas of well-being: physical, mental, nutritional, sleep, social, financial, and preventive care. The benefits and wellness package is designed to allow you to focus on what truly matters. Join us and experience the extensive resources and services designed to enhance your overall quality of life for you and your family.

NYU Langone Health is an equal opportunity employer and committed to inclusion in all aspects of recruiting and employment. All qualified individuals are encouraged to apply and will receive consideration. We require applications to be completed online.

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NYU Langone Health provides a salary range to comply with the New York state Law on Salary Transparency in Job Advertisements. The salary range for the role is $117,107.95 - $195,179.92 Annually. Actual salaries depend on a variety of factors, including experience, specialty, education, and hospital need. The salary range or contractual rate listed does not include bonuses/incentive, differential pay or other forms of compensation or benefits.

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