The University of Maryland Medical System
Senior Manager, Medical Economics - Remote
The University of Maryland Medical System, Baltimore, Maryland, United States, 21276
Senior Manager, Medical Economics - Remote
Full-time Shift: Day Position Type: Exempt The University of Maryland Medical System is a 14-hospital system with academic, community and specialty medical services reaching every part of Maryland and beyond. UMMS is a national and regional referral center for trauma, cancer care, Neurocare, cardiac care, women’s and children’s health and physical rehabilitation. UMMS is the fourth largest private employer in the Baltimore metropolitan area and one of the top 20 employers in the state of Maryland. No organization will give you the clinical variety, the support, or the opportunities for professional growth that you’ll enjoy as a member of our team. General Summary Responsible for planning and managing the functions of the Medical Economics team for the University of Maryland Medical System. Oversee the design and maintenance of complex data sets including commercial and federal claims data, EHR extracts, financial cost data and state and national healthcare claim benchmarks. Direct the analysis and evaluation of healthcare expenditures performance trends for various alternative healthcare payment models and performance comparisons to regional and national benchmarks and identify opportunities for improvement. Work is performed under general direction. Direct report to the Director or Senior Director, Medical Economics. Principal Responsibilities and Tasks The following statements are intended to describe the general nature and level of work being performed by people assigned to this classification. These are not to be construed as an exhaustive list of all job duties performed by personnel so classified. Develop workflow and implement policies and procedures. Ensure that department deliverables are met; accountable for ensuring completion of all tasks and projects. Provide oversight of work plan functions, due dates, and preparation of deliverables. Maintain knowledge of all functional areas within Reimbursement & Revenue Advisory Services. Guide data acquisition efforts: routinely evaluate available data resources and their value-add proposition to the department. Coordinate fiscal approvals and contract negotiations. Guide the identification and quantification of clinical interventions designed to lower medical and pharmacy cost/utilization. Manage the collaborative work effort between finance and other key stakeholders, including the collaboration of cross-department reporting. Routinely evaluates policy intent and outcomes for alternative payment methodologies and non-fee-for-service reimbursement. Works with the Director to develop policy modification proposals and positions for regulator entity, Health Services Cost Review Commission (HSCRC) and Centers for Medicare and Medicaid Innovation (CMMI). Coordinates UMMS executive buy-in for proposals to the industry and HSCRC; supports the negotiation/vetting of new policy proposals with industry leaders and commission staff. Guide efforts to identify anomalies in hospital performance under alternative payment methodologies; lead development of remediation plans for addressing anomalies. Guide development and implementation of simulation (proforma) modeling for alternative reimbursement methodologies, or non-fee-for-service finances. Guide evaluation of alternative reimbursement model performance to regional and national benchmarks, in addition to internal trends and data as available. Guide identification of performance improvement and financial opportunity areas and translate findings into clinical view for implementation; guide finance efforts to set performance improvement targets for utilization and cost; oversee the process to track and monitor performance to agreed-upon targets. Establish comprehensive metrics and reporting to evaluate team performance to ensure goals and objectives are being met. Identify and resolve operational and performance gaps and obstacles; recommend/implement changes and improvements. Lead development and coordination efforts for educational in-services for various departments related to alternative payment methodologies. Represent UMMS in industry meetings with other hospital leaders and commission staff related to population health measures and policies. Serve as the primary point of contact for hospital leadership regarding alternative payment methodologies. Provide subject matter expertise to internal and external stakeholders regarding HSCRC and CMMI population-based methodologies and Value-Based Care contracts. Provide strategic guidance on program participation and optimal implementation protocols for HSCRC Care Redesign Programs. Collaborate with various Value-Based Care teams to identify and capitalize on programmatic similarities and clinical focus areas to optimize performance in HSCRC programs. Identify, propose, validate, and implement process improvement opportunities for internal processes and reporting. Oversee fulfillment of ad-hoc data and reporting requests as needed. Prepare and lead meetings with clinical departments, hospital leadership, and internal stakeholders. Lead project teams to ensure effective planning, organizing, and management of projects and initiatives. Lead internal brainstorming sessions and the collaboration of project team members. Consciously creates a workplace culture of diversity, inclusivity consistent with the overall mission, vision, guiding principles and leadership values of the organization. Attend and participate in in-service training and various educational programs for continuous professional development. Foster a culture of collaboration, problem-solving, innovation, continuous learning, and a one-team mindset. Evaluate personnel effectiveness and develop/implement training programs to improve performance. Mentor staff in both technical and soft skills to craft a team of highly competent, consistent, thoughtful, and customer-centric experts. Perform managerial functions including hiring, discipline, training and development, and preparing and reviewing performance reviews in accordance with UMMS policies and procedures. Perform other duties as assigned. Education and Experience Bachelor’s degree in Health Sciences, Statistics, Mathematics, Public Health, Medical Economics, or related field, or the equivalent combination of education, training, and experience. Master’s degree preferred. Minimum 7 years’ experience in health care data interpretation, analysis, and reporting required. Minimum 3 years’ supervisory/managerial experience. 3+ years’ experience with SAS, SQL, Tableau, or similar relational databases and/or visualization software. Knowledge, Skills and Abilities Working knowledge of data flow and information systems in healthcare operations. Working knowledge of HSCRC/CMS regulations, Current Procedural Terminology, and ICD-10 coding. Proven leadership ability to successfully motivate and inspire team members to high-performance levels. Demonstrated ability to synthesize complex data sets into clear, actionable insights and strategic plans. Proven ability to lead teams effectively, prioritizing requests, and workload and establishing a goal-oriented work environment with clear and concise work procedures and productivity metrics. Advanced leadership skills, including situational awareness, conflict resolution, establishing alignment and clear direction, and driving continuous improvement. Advanced skill in presenting findings, conclusions, alternatives and information clearly and concisely at all levels within the organization. Advanced skill in developing and maintaining collaborative working relationships with all levels of leadership, staff, and vendors. Advanced skill in managing multiple staff initiatives and meeting changing requirements and priorities to accomplish objectives. Advanced skill in influencing, negotiating, and persuading to reach agreeable exchange and positive outcomes. Advanced analytical, conceptual thinking, planning, organizational, and problem-solving skills. Ability to analyze, compare, contrast, and validate work with keen attention to detail. Ability to work effectively in a matrixed work environment and to manage multiple deadline-driven tasks and projects. Ability to manage confidential issues with integrity and discretion. Expert skill in the use of Microsoft Office (e.g., Access, Word, Excel, PowerPoint, etc.). Advanced verbal, written, and interpersonal communication skills. All your information will be kept confidential according to EEO guidelines.
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Full-time Shift: Day Position Type: Exempt The University of Maryland Medical System is a 14-hospital system with academic, community and specialty medical services reaching every part of Maryland and beyond. UMMS is a national and regional referral center for trauma, cancer care, Neurocare, cardiac care, women’s and children’s health and physical rehabilitation. UMMS is the fourth largest private employer in the Baltimore metropolitan area and one of the top 20 employers in the state of Maryland. No organization will give you the clinical variety, the support, or the opportunities for professional growth that you’ll enjoy as a member of our team. General Summary Responsible for planning and managing the functions of the Medical Economics team for the University of Maryland Medical System. Oversee the design and maintenance of complex data sets including commercial and federal claims data, EHR extracts, financial cost data and state and national healthcare claim benchmarks. Direct the analysis and evaluation of healthcare expenditures performance trends for various alternative healthcare payment models and performance comparisons to regional and national benchmarks and identify opportunities for improvement. Work is performed under general direction. Direct report to the Director or Senior Director, Medical Economics. Principal Responsibilities and Tasks The following statements are intended to describe the general nature and level of work being performed by people assigned to this classification. These are not to be construed as an exhaustive list of all job duties performed by personnel so classified. Develop workflow and implement policies and procedures. Ensure that department deliverables are met; accountable for ensuring completion of all tasks and projects. Provide oversight of work plan functions, due dates, and preparation of deliverables. Maintain knowledge of all functional areas within Reimbursement & Revenue Advisory Services. Guide data acquisition efforts: routinely evaluate available data resources and their value-add proposition to the department. Coordinate fiscal approvals and contract negotiations. Guide the identification and quantification of clinical interventions designed to lower medical and pharmacy cost/utilization. Manage the collaborative work effort between finance and other key stakeholders, including the collaboration of cross-department reporting. Routinely evaluates policy intent and outcomes for alternative payment methodologies and non-fee-for-service reimbursement. Works with the Director to develop policy modification proposals and positions for regulator entity, Health Services Cost Review Commission (HSCRC) and Centers for Medicare and Medicaid Innovation (CMMI). Coordinates UMMS executive buy-in for proposals to the industry and HSCRC; supports the negotiation/vetting of new policy proposals with industry leaders and commission staff. Guide efforts to identify anomalies in hospital performance under alternative payment methodologies; lead development of remediation plans for addressing anomalies. Guide development and implementation of simulation (proforma) modeling for alternative reimbursement methodologies, or non-fee-for-service finances. Guide evaluation of alternative reimbursement model performance to regional and national benchmarks, in addition to internal trends and data as available. Guide identification of performance improvement and financial opportunity areas and translate findings into clinical view for implementation; guide finance efforts to set performance improvement targets for utilization and cost; oversee the process to track and monitor performance to agreed-upon targets. Establish comprehensive metrics and reporting to evaluate team performance to ensure goals and objectives are being met. Identify and resolve operational and performance gaps and obstacles; recommend/implement changes and improvements. Lead development and coordination efforts for educational in-services for various departments related to alternative payment methodologies. Represent UMMS in industry meetings with other hospital leaders and commission staff related to population health measures and policies. Serve as the primary point of contact for hospital leadership regarding alternative payment methodologies. Provide subject matter expertise to internal and external stakeholders regarding HSCRC and CMMI population-based methodologies and Value-Based Care contracts. Provide strategic guidance on program participation and optimal implementation protocols for HSCRC Care Redesign Programs. Collaborate with various Value-Based Care teams to identify and capitalize on programmatic similarities and clinical focus areas to optimize performance in HSCRC programs. Identify, propose, validate, and implement process improvement opportunities for internal processes and reporting. Oversee fulfillment of ad-hoc data and reporting requests as needed. Prepare and lead meetings with clinical departments, hospital leadership, and internal stakeholders. Lead project teams to ensure effective planning, organizing, and management of projects and initiatives. Lead internal brainstorming sessions and the collaboration of project team members. Consciously creates a workplace culture of diversity, inclusivity consistent with the overall mission, vision, guiding principles and leadership values of the organization. Attend and participate in in-service training and various educational programs for continuous professional development. Foster a culture of collaboration, problem-solving, innovation, continuous learning, and a one-team mindset. Evaluate personnel effectiveness and develop/implement training programs to improve performance. Mentor staff in both technical and soft skills to craft a team of highly competent, consistent, thoughtful, and customer-centric experts. Perform managerial functions including hiring, discipline, training and development, and preparing and reviewing performance reviews in accordance with UMMS policies and procedures. Perform other duties as assigned. Education and Experience Bachelor’s degree in Health Sciences, Statistics, Mathematics, Public Health, Medical Economics, or related field, or the equivalent combination of education, training, and experience. Master’s degree preferred. Minimum 7 years’ experience in health care data interpretation, analysis, and reporting required. Minimum 3 years’ supervisory/managerial experience. 3+ years’ experience with SAS, SQL, Tableau, or similar relational databases and/or visualization software. Knowledge, Skills and Abilities Working knowledge of data flow and information systems in healthcare operations. Working knowledge of HSCRC/CMS regulations, Current Procedural Terminology, and ICD-10 coding. Proven leadership ability to successfully motivate and inspire team members to high-performance levels. Demonstrated ability to synthesize complex data sets into clear, actionable insights and strategic plans. Proven ability to lead teams effectively, prioritizing requests, and workload and establishing a goal-oriented work environment with clear and concise work procedures and productivity metrics. Advanced leadership skills, including situational awareness, conflict resolution, establishing alignment and clear direction, and driving continuous improvement. Advanced skill in presenting findings, conclusions, alternatives and information clearly and concisely at all levels within the organization. Advanced skill in developing and maintaining collaborative working relationships with all levels of leadership, staff, and vendors. Advanced skill in managing multiple staff initiatives and meeting changing requirements and priorities to accomplish objectives. Advanced skill in influencing, negotiating, and persuading to reach agreeable exchange and positive outcomes. Advanced analytical, conceptual thinking, planning, organizational, and problem-solving skills. Ability to analyze, compare, contrast, and validate work with keen attention to detail. Ability to work effectively in a matrixed work environment and to manage multiple deadline-driven tasks and projects. Ability to manage confidential issues with integrity and discretion. Expert skill in the use of Microsoft Office (e.g., Access, Word, Excel, PowerPoint, etc.). Advanced verbal, written, and interpersonal communication skills. All your information will be kept confidential according to EEO guidelines.
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