Director PACE Health Plans

Inspire health. Serve with compassion. Be the difference.

Job Summary

This job under the leadership of the Administrator of Post-Acute Operations, is responsible for the development, planning, implementation and evaluation of the Palmetto Senior Consulting, a department providing consulting services to health care providers and state Medicaid agencies on a national level. The position is responsible for maintaining and expanding the growth of the department and its related fiscal viability. This role also provides leadership support for all back office (Finance/Outreach/Marketing) for the operational side of Pace at Prisma Health.

This job is under the leadership of the Executive Director in Post-Acute Division.

The position is responsible for maintaining and expanding the growth of the PACE Health Plans and its related fiscal viability and compliance. This role provides leadership support for all back-office functions to include, financial reporting and analytics, budgeting, admissions and marketing, revenue cycle, vendor management, accounts payable and health claims processing.

Accountabilities

• Provide effective leadership by coordinating and integrating services within their department, with other departments and with the hospital’s primary functions.
• Develop and implement policies and procedures that guide and support the provision of the services.
• Develop and implement budget including processes to monitor operational and capital costs.
• Manage department human resources by: determining qualifications, competence and performance expectations; planning, implementing and monitoring staffing plans; providing orientation, in-service training and continuing education of all persons in the department and applying policies/procedures pertaining to human resources management.
• Continuously assess and improve the department’s performance by designing operational processes, monitoring performance through data, analyzing the data, implementing sustainable performance improvement, and participating in multi-disciplinary inter-departmental PI activities.
• Manage information by providing information systems and data management for department operations and performance improvement.
• Provide effective leadership by coordinating and integrating services across PACE, with other departments and with the hospital’s primary function
• Develop and implement policies and procedures that guide and support the provision of the services.
• Duties include ensuring the financial viability/continued growth of the program through management of the insurance practices and compliance with federal and state regulations, as well as managing business relationships with all contracted providers and supporting the State and Federal relationships surrounding the PACE program
• Develop and implement PACE budgets, including processes to monitor operational and capital costs.
• Manage department human resources by determining qualifications, competence and performance expectations; planning, implementing and monitoring staffing plans; providing orientation, in-service training and continuing education of all persons in the department and applying policies/procedures pertaining to human resources management.
• Continuously assess and improve the department’s performance by designing operational processes, monitoring performance through data, analyzing the data, implementing sustainable performance improvement, and participating in multi-disciplinary inter-departmental PI activities.
• Manage information by providing information systems and data management for department operations and performance improvement.
• Responsible for overall financial performance for PACE health plan operations.
• Provide oversight for all financial activities related to PACE.
• Provide oversight for intake/outreach of the PACE program and strategically growing the program across Prisma Health service area.
• Develop strategic direction alongside clinical operations director of the PCE programs.
• Manage Part D bid for Pharmacy claims. Responsible for the oversight of Medicare Part D accounting tasks related to patient accounts at the team level, including accurate entry of Medicare and/or Medicaid information necessary to bill for services provided and ensuring the proper certifications are completed before a bill is submitted to the intermediary.
• Manage required communications with Medicare, HPMS, for operations of PACE Health Plans.
  
  

Supervisory/Management Responsibilities

Job has direct and/or indirect supervision of employees that may include final budget authority, hire/termination/disciplinary authority, performance appraisal responsibility. Job will be considered a member of the management staff with direct reports.

Minimum Education

Master’s in Health Administration or Business Administration

Minimum Experience

2 to 5 years’ experience in PACE and health care consulting with a demonstrated record of progressive professional leadership responsibility. Knowledge of Medicare, Medicaid and insurance billing is required. Experience in working with ICD-10 coding and HCPCS is desirable.

Other Required Experience

Must have a good understanding of all aspects of operations of PACE model, health plan operations or managed care models. Must be proficient in the development of business plans, financial models, and health care financing. Excellent oral and written communication skills are needed, including proficiency in Excel, Word and other software necessary to develop extensive feasibility analysis.

Must have demonstrated experience in coordinating the planning, directing and evaluation of patient care; effective communication and conflict resolution skills.

Work Shift

Day (United States of America)

Location

Centennial Way Practices

Facility

1039 SeniorCare PACE - Upstate

Department

10399035 Administrative and General

Share your talent with us! Our vision is simple: to transform healthcare for the benefits of the communities we serve. The transformation of healthcare requires talented individuals in every role here at Prisma Health.

R1100395