For more information about this position contact:Linnea CornishTalent Acquisition Partnerlinnea.email@example.com 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
For more information about this position contact:Linnea CornishTalent Acquisition Partnerlinnea.firstname.lastname@example.org Performs advanced case management and intervention for high risk members of the Tuality Health Alliance by using a collaborative process which assesses, plans, implements, coordinates, monitors and evaluates the options and services to meet an individual's health needs using communication and available resources to promote quality and, cost effective outcomes. Provides support for primary care practices to function as patient-centered medical homes through direct member support, process improvement, and provision of linkage to community resources. Analyzes patient medical records concurrently and/or retrospectively for utilization review, quality assessment, risk management and discharge planning criteria. Provides leadership for the development and implementation of quality improvement activities. Provides back-up for Utilization Review Nurse as necessary.
Tuality Health Alliance-90109
Full Time (80 hours per pay period)
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