Senior Director, MRA Optimization

Alignment Health is breaking the mold in conventional health care, committed to serving seniors and those who need it most: the chronically ill and frail. It takes an entire team of passionate and caring people, united in our mission to put the senior first. We have built a team of talented and experienced people who are passionate about transforming the lives of the seniors we serve. In this fast-growing company, you will find ample room for growth and innovation alongside the Alignment Health community. Working at Alignment Health provides an opportunity to do work that really matters, not only changing lives but saving them. Together.

The MRA Optimization Senior Director will lead efforts to streamline operations, reduce costs, and improve pa-tient outcomes. You will lead initiatives to improve operational efficiency, quality, and profitability by analyzing processes, identifying areas for improvement, and implementing changes using data-driven approaches and best practices.

The position requires strong collaboration with the MRA leadership team to prioritize, develop, implement and monitor performance improvements and metrics related to MRA operations.

The Sr. Director will be accountable for the strategic and operational excellence of the MRA function including administrative and care cost initiatives, system development and delivery of high-quality out-comes, compliance with all state and federal regulations that affect MRA activities and executive level reporting, and communication as needed

Job Duties/Responsibilities:

• Process Analysis and Improvement:

Develop and implement process improvement strategies.

Designs and implements operational strategies to drive efficiency, cost reduction, and scalability across the organization (SG&A and MLR)

Lead the change management process and monitor changes to ensure success.

• Data Analysis, Reporting and Financial Acumen:

Participate in the establishment, monitoring, and reporting of key metrics to manage performance related to MRA processes and functions.

Use data to identify opportunities for improvement and measure the impact of changes.

Prepare reports and presentations to communicate findings and recommendations including business case and proforma development.

Collaborate with financial and operational leaders to build annual budget and operating plan

Translate performance metrics to financial drivers and outcomes and calculate return on investments of improvement initiatives.

• Leadership and Communication:

Leads departmental strategic planning and the establishment of strategic direction. 

Provide guidance and advice to senior leaders and other stakeholders.

Communicate the benefits of process improvements to the organization.

Collaborates with various departments, including physicians, nurses, and other healthcare professionals, to promote effective practices

Manage and mentor team members, if applicable.

• Continuous Improvement:

Stay up-to-date on industry trends and best practices.

Lead and implement a "best-in-class" continuous improvement strategy.

Innovate and implement new or revised models for the Organization's Medicare Risk Adjustment operations functions in response to evolving trends in healthcare delivery and/or emerging models of care.  

Build strategic initiative roadmap for improvement with cross functional partners including DTS and operational resources

• Policy Management

Ensures compliance with relevant regulations and standards.

Ensuring that revised and new policies are implemented.

Job Requirements:

Experience:

Required:

• Minimum 7 years of experience in process improvement, product roll out/launch, project management, implementation and operational performance management with at least 3 years in a leadership role.
• 3-5 years of experience in clinical services and/or health plan care management functions
• Experience in Medicare Risk Adjustment 

Preferred:

• Healthcare or Insurance industry experience

Education:

Required:

• Bachelor's degree or four years additional experience in lieu of education.

Preferred:

• MBA or MHA

Specialized Skills:

• Required:

• Solid understanding of health plan operations and their impact on financial performance
• Ability to communicate positively, professionally and effectively with others; provide leadership, teach and collaborate with others.
• Effective written and oral communication skills; ability to establish and maintain a constructive relationship with diverse members, management, employees and vendors;
• Mathematical Skills:  Ability to perform mathematical calculations and calculate simple statistics correctly
• Project & client management skills - ability to scope projects, create workable project plans, closely partner with key stakeholders, and execute on such plans while demonstrating an ability to balance multiple competing priorities
• Reasoning Skills:  Ability to prioritize multiple tasks; advanced problem-solving; ability to use advanced reasoning to define problems, collect data, establish facts, draw valid conclusions, and design, implement and manage appropriate resolution.
• Problem-Solving Skills:  Effective problem solving, organizational and time management skills and ability to work in a fast-paced environment.
• Report Analysis Skills:  Comprehend and analyze statistical reports.

Essential Physical Functions:

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job.  Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

1.  While performing the duties of this job, the employee is regularly required to talk or hear. The employee regularly is required to stand, walk, sit, use hand to finger, handle or feel objects, tools, or controls; and reach with hands and arms.

2. The employee frequently lifts and/or moves up to 10 pounds. Specific vision abilities required by this job include close vision and the ability to adjust focus.

Pay Range: $149,882.00 - $224,823.00

Alignment Health is an Equal Opportunity/Affirmative Action Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, age, protected veteran status, gender identity, or sexual orientation.

*DISCLAIMER: Please beware of recruitment phishing scams affecting Alignment Health and other employers where individuals receive fraudulent employment-related offers in exchange for money or other sensitive personal information. Please be advised that Alignment Health and its subsidiaries will never ask you for a credit card, send you a check, or ask you for any type of payment as part of consideration for employment with our company. If you feel that you have been the victim of a scam such as this, please report the incident to the Federal Trade Commission at https://reportfraud.ftc.gov/#/. If you would like to verify the legitimacy of an email sent by or on behalf of Alignment Health’s talent acquisition team, please email careers@ahcusa.com.

Salary : $149,882 - $224,823