We are hospitals and affiliated medical groups, working closely together for the benefit of every person who comes to us for care. We build comprehensive networks of quality healthcare services that are designed to offer our patients highly coordinated, personalized care and help them live healthier lives. Through collaboration, we strive to provide all of our patients and medical group members with the quality, affordable healthcare they need and deserve.

Responsible for developing, implementing, and monitoring strategy for MSO Clients, and assigned PMS expansion markets, on a national level, to drive membership growth, advantageous health plan and hospital contracts, effective provider networks and strong financial & quality performance. Works collaboratively with Prospect Medical Systems to achieve goals, while ensuring compliance with company, regulatory, health plan and contractual requirements. Responsible for ensuring successful support of Coordinated Regional Care (C-R-C) operations in non-California expansion markets and for new product lines, including education of local market, building strong relationships with key constituents and operationalizing payor contracts. In addition, ensures effective transition of CRC operations & new PMS business to MSO at transition point by implementing initial support services consistent with post-transition processes. Continually looks to identify technology and procedure improvements for increased efficiencies, accuracy, and continuous process enhancements - with a commitment to standardizing & automating when possible.

Job Responsibilities/Duties

• In collaboration with SVP of National Network Management & MSO, ensures successful launch and development in assigned non-California expansion markets, new Clients, and select C-R-C product lines by understanding contractual & regulatory requirements for business model, risk-taking entity, health plan contracts and MSO support services & structure. Educates market constituents (IPA Board members, Hospital Executives, Health Plans, Physician Leaders, PCPs, and specialists) regarding MSO operations and support services. Educates MSO departments on support services by market and ensures MSO performance at established contractual performance levels (both quality and timeliness) to support financial reporting & analysis, eligibility processing, claims payment, provider contracting & credentialing, medical management, quality metrics, HCC capture, project management. Conducts regular meetings with senior leadership to communicate status of goals and recommendations for corrective actions, as needed.
• Responsible for meeting MSO revenue goals while building and managing effective relationships with Clients’ senior management teams and non-California PMS & CRC teams. Ongoing evaluation of each Client and market and development & implementation of Client-specific / market-specific strategies that benefit Prospect & Client and drive: membership growth, revenue enhancement & cost reductions and advantageous health plan and hospital contracts/relationships. Develop reports to effectively monitor these strategic initiatives and develop action plans to address performance levels.
• Provide leadership, mentoring and management to IPA Administrators and Network Managers to advance team members while developing metrics and tools to measure progress on providing meaningful/actionable data to Clients and local market leaders, building strong relationships with providers, driving performance of network and being an effective liaison with Prospect departments.
• Timely management of MSO client reports, audit preparation, physician onboarding, CSR reporting and interdepartmental needs including BOD packets & compliance-related items.

Qualifications

Minimum Education: Bachelor’s degree, or equivalent education and experience required. Advanced degree preferred or equivalent experience in IPA setting.

Minimum Experience: At least eight (8) years’ experience in managed healthcare, preferably IPA. Strong knowledge of and proven success improving quality performance metrics. Demonstrated success in process improvement, cost reduction and improving efficiencies. Extensive knowledge of managed care guidelines and regulations for delegated models, including all lines of business. Application of appropriate interventions and follow up on identified issues/projects. Strong computer skills, data entry, Word, Excel, Power Point, and office equipment.

Req. Certification/Licensure: None

Employee Value Proposition

Prospect Medical Holdings, Inc., is guided by a diverse and highly experienced leadership core. This group maintains the vision that has made Prospect a needed difference-maker in the lives of so many patients today, and many executives contribute to our continued efforts. As a member of our highly effective team of professionals, benefit eligible positions will receive:

• Company 401K
• Medical, dental, vision insurance
• Paid time-off
• Life insurance

How to Apply

To apply for this role, or search our other openings, please visit http://pmh.com/careers/ and click on a location to begin your journey to a new career with us!

We are an Equal Opportunity/ Affirmative Action Employer and do not discriminate against applicants due to veteran status, disability, race, gender, gender identity, sexual orientation or other protected characteristics. If you need special accommodation for the application process, please contact Human Resources.

EEOC is the Law: https://www.eeoc.gov/