Offer summary

Qualifications:

Bachelor's Degree in Finance, Business Administration, Healthcare Management or related field required; MBA preferred., Minimum of 3 years leadership experience in a healthcare or managed care setting., At least 5 years of experience in healthcare and managed care, with a focus on economics, analytics, project management, underwriting, or actuarial science., Demonstrated advancement and leadership in a corporate environment is essential..

Key responsibilities:

Lead the overall Cost of Care program across Sentara Health Plans, focusing on total cost management.

Engage with Network Management and Utilization Management to implement cost remediation and management solutions.

Collaborate with Operations to enable changes in patient liability and processing rules.

Work with Product, Actuary, and Underwriting teams to improve benefit design and validate cost trends.

Job description

City/State

Virginia Beach, VA

Work Shift

First (Days)

Overview:

Sentara Health is seeking to hire a qualified individual to join our team as Director, Cost of Care

Position Status: Full-time, Day Shift

Position Location: This position is remote.

Standard Working Hours: 8:00AM to 5:00PM (ET).

Minimum Requirements:

Bachelor’s Degree required.
3 years leadership experience required.
5 years healthcare and managed care experience required.

Expectations for this Role:

The Director, Cost of Care leads the overall Cost of Care program across Sentara Health Plans. Focuses on total Cost of Care including professional, facility (inpatient and outpatient), and ancillary medical cost on a per member per month basis and trend. Leverages industry knowledge, analytical skills, and multi-disciplinary engagement skills to lead the Cost of Care program design, execution and progress tracking. Engages with Network Management on unit cost remediation, network sculpting programs, and contractual amendments enabling execution of Cost of Care, Utilization Management and Medical Management solutions. Engages with Utilization Management on pre-authorization requirements, site of service redirection, and commodity management programs like Specialty Pharmacy. Significant interaction with Operations to effectively enable changes in Patient Liability, Out of Network processing, bundling edit improvements and limits, secondary and subsequent processing rules. Collaboratively works with Product on benefit design improvements. Partners with Actuary and Underwriting for unit cost and trend validation and roll-up into premium pricing.

Bachelor's Degree Required in Finance, Business Administration, Healthcare Management or related field. MBA preferred. Knowledge, skills and abilities normally obtained through five years of experience in an insurance and/or health care organization. Prior experience in economics, analytics, project management, underwriting or actuarial science highly desired. Experience should show consistent advancement and leadership in the corporate environment.

Sentara Health Overview

Sentara Health, an integrated, not-for-profit health care delivery system, celebrates more than 130 years in pursuit of its mission - "We improve health every day." Sentara is one of the largest health systems in the U.S. Mid-Atlantic and Southeast, and among the top 20 largest not-for-profit integrated health systems in the country, with 30,000 employees, 12 hospitals in Virginia and Northeastern North Carolina, and the Sentara Health Plans division which serves more than 1 million members in Virginia and Florida. Sentara is recognized nationally for clinical quality and safety and is strategically focused on innovation and creating an extraordinary health care experience for our patients and members. Sentara was named to IBM Watson Health's "Top 15 Health Systems" (2021, 2018), and was recognized by Forbes as a "Best Employer for New Grads" (2022), "Best Employer for Veterans" (2022), and "Best Employer for Women" (2020).

Mission, Purpose, and Values

Mission – We improve health every day.
Purpose – Sentara exists to be the trusted partner to individuals and the community in their journey to health and well-being.
Values – People, Quality, Patient Safety, Service, and Integrity.

Sentara Healthcare Commitments

Sentara has made a commitment to its colleagues, patients, and members to:

Always keep you safe.
Always treat you with dignity, respect, and compassion.
Always listen and respond to you.
Always keep you informed and involved.

Benefits: Caring For Your Family and Your Career

• Medical, Dental, Vision plans

• Adoption, Fertility and Surrogacy Reimbursement up to $10,000

• Paid Time Off and Sick Leave

• Paid Parental & Family Caregiver Leave

• Emergency Backup Care

• Long-Term, Short-Term Disability, and Critical Illness plans

• Life Insurance

• 401k/403B with Employer Match

• Tuition Assistance – $5,250/year and discounted educational opportunities through Guild Education

• Student Debt Pay Down – $10,000

• Reimbursement for certifications and free access to complete CEUs and professional development

•Pet Insurance
•Legal Resources Plan
•Colleagues have the opportunity to earn an annual discretionary bonus if established system and employee eligibility criteria is met.

Sentara Health is an equal opportunity employer and prides itself on the diversity and inclusiveness of its close to an almost 30,000-member workforce. Diversity, inclusion, and belonging is a guiding principle of the organization to ensure its workforce reflects the communities it serves.

In support of our mission “to improve health every day,” this is a tobacco-free environment.

For positions that are available as remote work, Sentara Health employs associates in the following states:

Alabama, Delaware, Florida, Georgia, Idaho, Indiana, Kansas, Louisiana, Maine, Maryland, Minnesota, Nebraska, Nevada, New Hampshire, North Carolina, North Dakota, Ohio, Oklahoma, Pennsylvania, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, Washington, West Virginia, Wisconsin, and Wyoming.

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