The Director Tuality Health Alliance (THA) and Tuality Health Plan Services (THPS) at Tuality Healthcare is responsible for the overall operations of various products and plans operated by THA or THPS, including Oregon Health Plan, Tuality Healthcare Employee Trust, and others that may be developed in the future. The Director works collaboratively with THC Executive and in matrix reporting to OHSU Office of Payer relations. Director has oversight of the operations of the THA Medical Management Program, including Quality Improvement and Utilization Management and participates on all related committees.
Responsible for the oversight of the operations of the THA Medical Management Program, including Quality Improvement and Utilization Management and participates on all related committees. Works with the Alliance leadership physicians, THC President and Board of Directors to set meeting agendas, present content, and develop programs to enhance quality and clinical integration.
Execute on the operational strategy for Tuality Health Plan Services:
· Responsible for the operations of Tuality Health Plan Services under direct supervision of THC President and in collaboration with OHSU Office of Payer Strategy.
· Facilitates contract negotiations through various committee structures, Board by-laws, and regulatory standards on behalf of Provider and Corporate Member(s)
· Responsibility for overall financial performance of the THA & THPS businesses, both from an internal operational perspective (FTE’s, expenses, etc) and also from a healthplan or PMPM perspective
· Work collaboratively with to develop a comprehensive strategy and marketing program to increase and improve access for patients to services within the network.
· Developing and maintaining strong relationships with other organizations, both in the healthcare industry and in the community
Execute on the operational strategy for Tuality Health Alliance:
· Responsible for the oversight of Customer Service, Provider Relations, Claims, Risk and Reimbursement, and relevant third party applications and reporting systems
· Responsible for the operations of Health Alliance Case Departments and employees including discharge planning, social workers services, concurrent review and catastrophic case management.
· Work collaboratively with THC to develop a comprehensive strategy and marketing program to increase and improve access for patients to services within the network.
· Ensures compliance with Oregon Health Authority CCO commitment, metrics and standards striving toward the triple aim of better health, better quality and lower costs. Successful completion of OHA and other regulatory audit(s)
· Responsible for the oversight of the operations of the THA Medical Management Program, including Quality Improvement and Utilization Management and participates on all related committees.
Oversees compliance and regulatory standards:
· Directs and leads compliance with regulatory entities, including third party contracting requirements
· Oversees the compliance with insurance concerns of the corporation.
· Oversees proper operation of the corporate compliance program, the internal control systems, and balance sheets of THA & THPS in partnership with VP of Finance.
· Able to effectively represent THA and THPS to outside committees, regulatory bodies and in organizations
1) Bachelor’s degree in Business Administration
2) Minimum 5 years healthcare experience
1) Master’s degree business or healthcare administration preferred
2) Demonstrated clinical integration experience
3) Background in insurance operations preferred and involvement with payer contracting negotiations
Job Related Knowledge, Skills, and Abilities:
· Ability to process and handle confidential information with discretion
· Ability to adapt to change quickly and positively
· Ability to lead and facilitate effective teams
· Ability to support multiple initiatives and balance priorities
· Excellent written and verbal communication skills
· Superior organization and time management skills
· Self-motivated and able to work autonomously
· Strong project management and critical thinking/analytical skills
· Proficiency in Microsoft Office applications
· Knowledge of legal, quality and regulatory requirements
· Proficiency in analytics and database systems
At Tuality Healthcare, an OHSU Partner, it's an honor and a privilege to serve those near us. That's why since our beginnings in 1918, and as we expand our strong network of services through our clinical affiliation with OHSU, we continue to be committed to providing the best health care possible and a valued community partner. Our affiliation with OHSU brings the advanced medical resources of Oregon’s only academic health center, which allows local providers to receive guidance from some of the country’s top specialists and pass that expertise on to Tuality patients where they can be cared for in their community.
Tuality’s many awards showcase our position as one of the Portland metro area’s premier healthcare providers, including 5th straight year in Top 10 Healthiest Employers in Oregon from The Portland Business Journal, Tuality’s 6th straight Gold Plus Award from the American Heart Association, and 2016 #1 Nationwide Best Hospital IT Department to work for according to Healthcare IT News.
Here at Tuality our employees care about making a difference. In fact, they care so much that in our most recent employee satisfaction survey we had an 80% participation rate! Tuality is truly unique because of the relationships we build and as individuals we are seen and heard. Come be part of our team, and let your voice be heard!