Director, Payor Strategy

Atlanta, GA | Corporate Operations

Position Summary:

At GoHealth Urgent Care, we place the needs of our patients first - by providing an effortless patient experience, a welcoming culture of care and seamless integration with market-leading health systems and our communities.
 
Reporting to our Chief Strategy Officer, the Director of Value Based Care will lead GoHealth's execution and delivery of value-based care initiatives with a focus on growth, value payment capture, total cost of care, and quality. The director will assist in updating initiatives and lead all aspects of the end-to-end delivery for these products to our health system partners and their payors.  The director will assist in creating new frameworks and processes to operationalize GoHealth's value-based strategy to execute business strategies that proactively drive results with our partners.
 
Essential Job Responsibilities
  • Lead and deliver value-based care initiatives with performance goals of:
    • Timeliness
    • High compliance yield of patient target behavior (including prioritizing financially material ROI)
    • Patient and payor satisfaction
  • Grow the value-based care initiatives with existing payors in:
    • breadth/type of Value Based Care (VBC)
    • depth of VBC initiatives (such as more of the payor's plans in their portfolio)
    • geography with the national/regional payors that operate in multiple markets
  • Partner with key collaborators to ensure and support the successful execution of our value-based care initiatives and programs including but not limited to:
    • The local GoHealth operations team (market president, medical director, and marketing)
    • Corporate support departments (information technology, data analytics, and revenue cycle)
    • Our Joint Venture partner such as managed care department and population health group (and possibly the Accountable Care Organization (ACO)
  • Assist in the program modifications/iterations needed to improve the existing value-based initiatives portfolio performance and design new products that create additional value enhancing initiatives with existing partners and/or new partners. The emergency room initiative will be a special emphasis.
  • Support value-based initiative pitches and sales to payors and employers by preparing summary snapshots that demonstrate our performance.
  • Communicate opportunities and performance through monthly and/or quarterly meetings with one or all the following:
    • JV partner's operations, managed care, population health and ACO teams
    • Payors or employers
    • GH local operations and support teams
  • Develop relationships to gain insight on value-based care needs and opportunities with current and future joint venture health systems, and leading payors in the markets.
  • Support new health system payor negotiations and contracts with the goal of optimizing reimbursement.
  • Other duties as assigned.
Candidate Qualifications:
  • Bachelor's degree in related area (Master's degree preferred).
  • 5 or more years of progressive responsibility in healthcare operations, strategy, or consulting.
  • Experience with the delivery of Value Based Care initiatives.
  • A self-motivated, independent, highly driven and results focused individual.
  • Ability to analyze and resolve complex logical issues.
  • Attention to detail, professional demeanor, thorough and logical approach.
  • Ability to be a team player who motivates and educates other team members.
  • General knowledge of healthcare business processes and the associated drivers.
  • Ability to leverage best practices, analytics, and data-driven processes to develop new and innovative value-based care products.
UPDATE: COVID Vaccine Announcement: GoHealth Urgent Care is requiring all new hires to disclose their COVID-19 vaccination status in all markets. In certain markets, it will be required that new hires receive the first dose of the COVID-19 vaccine series (of either the Moderna or Pfizer vaccine or the single dose Johnson & Johnson Janssen vaccine) prior to their first day of employment. New hires must receive the second dose (of either the Moderna or Pfizer vaccine) within 30 days of their first day of employment. This is a condition of employment, unless a faith-based or medical exemption is approved.

All qualified persons are granted an equal opportunity for employment without regard to race, color, religion, sex, sexual orientation and gender identity or expression, age, national origin, citizenship status, disability, genetic information, medical condition, family care leave status, pregnancy or pregnancy-related condition, otherwise qualified disabled or veteran status. The company will comply with all fair employment laws in each of the jurisdictions where we conduct business.


Keywords:
Job, emergency, healthcare, licensure, medical, clinical, wellness, career, employment, opening, staff, benefits, health care, clinic, primary care, urgent care


Why GoHealth?

GoHealth Urgent Care has outstanding career opportunities in Connecticut, Delaware, Missouri, New York City, North Carolina, Northwest Arkansas, Oklahoma City, San Francisco and the Portland-Vancouver area. And all of these positions have one thing in common: flexibility to practice urgent care medicine the way it was meant to be, without the stress and bureaucracy of hierarchical organizations. With reasonable work hours that don’t emotionally exhaust them or burn them out, our team can balance and prioritize their professional and personal lives.

The lifestyle you can lead.

Atlanta is Georgia’s state capital and home to approximately half a million residents. Well known for its arts, theater, galleries and museums, cultural attractions, and institutions of higher education, Atlanta offers many things to do. Visit Georgia Aquarium, the largest public aquarium in the Western Hemisphere. Shop and enjoy great entertainment in Underground Atlanta. See wildlife shows at Zoo Atlanta. Catch a pro football, basketball or baseball game. Foodies will delight in local favorites, such as crab fritters, chicken biscuits, pulled pork sandwiches and salted caramel ice cream. Choose from many welcoming neighborhoods to live in, from downtown and midtown to Chastain Park, and from Buckhead to Cabbagetown, Kirkwood and Morningside. There’s also a good selection of public and private schools and nearby colleges and universities. Public transportation is excellent, and Atlanta is also served by Amtrak and Hartsfield-Jackson Atlanta International Airport.