Cost of Care Director
PacificSource

Job Info

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Looking for a way to make an impact and help people?

Join PacificSource and help our members access quality, affordable care!

PacificSource is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to status as a protected veteran or a qualified individual with a disability, or other protected status, such as race, religion, color, national origin, sex, sexual orientation, gender identity or age.

Diversity and Inclusion: PacificSource values the diversity of the people we hire and serve. We are committed to creating a diverse environment and fostering a workplace in which individual differences are appreciated, respected and responded to in ways that fully develop and utilize each person's talents and strengths.

This position plays a crucial role in managing and optimizing the costs associated with healthcare delivery. Responsibilities include working with executive management to build and oversee a comprehensive cost of care program that spans across PacificSource in support of achieving Enterprise and business unit financial goals. Responsibilities require a combination of strategic thinking across all lines of business, leadership, and detailed operational management to ensure that healthcare delivery is both cost-effective and of high quality.

Essential Responsibilities:

• Develop and implement strategies to manage healthcare costs. This includes analyzing cost-benefit scenarios and justifying variances in business plans.
  
• Lead value-add programs, ensuring they are effectively planned, implemented, and monitored. This involves coordinating with various departments such as Actuarial/Medical Economics, IT/Analytics, Provider Network, Health Services, Government and Commercial operations, Compliance, and Legal. Serve as a lead facilitator among key stakeholders to ensure effective implementation and compliance with contractual arrangements.
  
• Responsible for budget development and oversight, ensuring cost containment without compromising quality of care.
  
• Conduct thorough analyses of healthcare costs, identifying trends, variances, and areas for improvement.
  
• Provide training to staff on cost management practices and tools.
  
• Work with Actuarial, Medical Economics, and Analytics to develop and implement outcome measures to assess Cost of Care program effectiveness. This includes ongoing reporting and monitoring to identify areas of over- and under-utilization and opportunities for improvement.
  
• Ensure compliance with regulatory requirements and maintain accurate program documentation.
  
• Interpret the impact of broad-scope organizational change for staff and develop change strategies for successful implementation.
  
• Prepare and present regular reports on cost of care metrics to senior leadership and stakeholders.
  
• Lead initiatives aimed at improving efficiency and reducing unnecessary costs without compromising care quality.
  

Supporting Responsibilities:

• Meet department and company performance and attendance expectations.
  
• Follow the PacificSource privacy policy and HIPAA laws and regulations concerning confidentiality and security of protected health information.
  
• Perform other duties as assigned.
  

SUCCESS PROFILE

Work Experience: Minimum seven (7) years of experience in healthcare finance, cost analysis, or a related area. Minimum of three (3) years management or supervisory experience required. Experience with Commercial, Medicare, and Medicaid administrative operations is preferred. Experience in an integrated healthcare system preferred

Education, Certificates, Licenses: A bachelor's degree in healthcare administration, business administration, finance, or a related field required. A master's degree is preferred.

Knowledge: Strong analytical skills with proficiency in data analysis tools and methodologies. Excellent communication and interpersonal skills to include the ability to negotiate and resolve conflicts and build teams. Knowledge of healthcare regulations and reimbursement models. Competence to function independently and deal with multiple, simultaneous projects Comprehensive knowledge of business principles and techniques of administration, organization, and management to include an in-depth understanding of key business issues that exist in the healthcare industry. Knowledge of strategic and operational planning, healthcare economics, personnel administration, federal health reform laws, financial and cost analysis, trends in the healthcare industry, and delivery system transformation

Competencies

• Authenticity
  
• Building Organizational Talent
  
• Coaching and Developing Others
  
• Compelling Communication
  
• Customer Focus
  
• Empowerment/Delegation
  
• Emotional Intelligence
  
• Leading Change
  
• Managing Conflict
  
• Operational Decision Making
  
• Passion for Results
  

Environment: Work inside in a general office setting with ergonomically configured equipment. Travel is required approximately 25% of the time.

Skills:

Our Values

We live and breathe our values. In fact, our culture is driven by these seven core values which guide us in how we do business:

• We are committed to doing the right thing.
• We are one team working toward a common goal.
• We are each responsible for customer service.
• We practice open communication at all levels of the company to foster individual, team and company growth.
• We actively participate in efforts to improve our many communities-internally and externally.
• We actively work to advance social justice, equity, diversity and inclusion in our workplace, the healthcare system and community.
• We encourage creativity, innovation, and the pursuit of excellence.

Physical Requirements: Stoop and bend. Sit and/or stand for extended periods of time while performing core job functions. Repetitive motions to include typing, sorting and filing. Light lifting and carrying of files and business materials. Ability to read and comprehend both written and spoken English. Communicate clearly and effectively.

Disclaimer: This job description indicates the general nature and level of work performed by employees within this position and is subject to change. It is not designed to contain or be interpreted as a comprehensive list of all duties, responsibilities, and qualifications required of employees assigned to this position. Employment remains AT-WILL at all times.

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