Company:
AHI agilon health, inc.
Job Posting Location:
Remote - USA
Job Title:
Quality and Health Plan Relations Manager
Job Description:
Essential Job Functions:
- Participate in Health Plan JOCs: Engage in Joint Operating Committees (JOCs) with health plans to review performance metrics, discuss improvement strategies, and address any concerns.
- Contracting Collaboration: Work closely with the contracting team on health plan contracted measures for new contracts and renewals, including managing incentives and penalties.
- Health Plan Communication: Communicate and track all cross market wide health plan updates and/or notices
- Health Plan Point of Contact for Rejections: Engage with health plans to work through review of submitted gap closure rejections
- Health Plan Incentive and Penalties: Work with multiple departments to ensure that the status of the markets are up to date and that the tools associated with tracking the information are correct
- Reporting and Presentations: Prepare detailed reports and presentations on quality performance and Star ratings for senior management, including actionable plans and recommendations.
- Lead Improvement Efforts: Head quality improvement initiatives through specialized subgroups.
- Best Practice Sharing: Identify and share best practices across markets as it relates to quality
- Quality Gap Reconciliation: Collaborate on activities related to reconciling quality gap submissions.
- Regulatory Updates: Stay informed about changes in regulations, healthcare quality measures, and industry best practices.
- Project Assistance: Assist and support the Director of Quality Performance with various projects as needed.
- Additional Duties: Perform other duties as assigned to meet the organization’s needs
Other Job Functions:
- Understand, adhere to, and implement the Company’s policies and procedures.
- Provide excellent customer services skills, including consistently displaying awareness and sensitivity to the needs of internal and/or external clients. Proactively ensuring that these needs are met or exceeded.
- Take personal responsibility for personal growth including acquiring new skills, knowledge, and information.
- Engage in excellent communication which includes listening attentively and speaking professionally.
- Set and complete challenging goals.
- Demonstrate attention to detail and accuracy in work product.
Required Qualifications:
Minimum Experience:
- 5+ years prior experience in a health insurance or healthcare setting.
- Understanding of healthcare quality measures (e.g., HEDIS, CAHPS, STARS, CMS).
- Excellent oral and written communication skills.
- Strong relationship-building skills.
- Proficiency in Microsoft Office (Word, Excel, PowerPoint).
Education/Licensure:
- Bachelor’s degree in business administration, Healthcare Management, or a related field, or equivalent experience.
Location:
Remote - TX
Pay Range:
$100,000.00 - $122,600.00
Salary range shown is a guideline. Individual compensation packages can vary based on factors unique to each candidate, such as skill set, experience, and qualifications.
