Director, Cost of Care

City/State

Work Shift

Overview:

Sentara Health is seeking to hire a qualified individual to join our team as Director, Cost of Care

Position Status: Full-time, Day Shift

Position Location: This position is remote.

Standard Working Hours: 8:00AM to 5:00PM (ET).

Minimum Requirements:

• Bachelor's Degree required.
• 3 years leadership experience required.
• 5 years healthcare and managed care experience required.

Expectations for this Role:

The Director, Cost of Care leads the overall Cost of Care program across Sentara Health Plans. Focuses on total Cost of Care including professional, facility (inpatient and outpatient), and ancillary medical cost on a per member per month basis and trend. Leverages industry knowledge, analytical skills, and multi-disciplinary engagement skills to lead the Cost of Care program design, execution and progress tracking. Engages with Network Management on unit cost remediation, network sculpting programs, and contractual amendments enabling execution of Cost of Care, Utilization Management and Medical Management solutions. Engages with Utilization Management on pre-authorization requirements, site of service redirection, and commodity management programs like Specialty Pharmacy. Significant interaction with Operations to effectively enable changes in Patient Liability, Out of Network processing, bundling edit improvements and limits, secondary and subsequent processing rules. Collaboratively works with Product on benefit design improvements. Partners with Actuary and Underwriting for unit cost and trend validation and roll-up into premium pricing.

Bachelor's Degree Required in Finance, Business Administration, Healthcare Management or related field. MBA preferred. Knowledge, skills and abilities normally obtained through five years of experience in an insurance and/or health care organization. Prior experience in economics, analytics, project management, underwriting or actuarial science highly desired. Experience should show consistent advancement and leadership in the corporate environment.

Sentara Health Overview

Sentara Health, an integrated, not-for-profit health care delivery system, celebrates more than 130 years in pursuit of its mission - "We improve health every day." Sentara is one of the largest health systems in the U.S. Mid-Atlantic and Southeast, and among the top 20 largest not-for-profit integrated health systems in the country, with 30,000 employees, 12 hospitals in Virginia and Northeastern North Carolina, and the Sentara Health Plans division which serves more than 1 million members in Virginia and Florida. Sentara is recognized nationally for clinical quality and safety and is strategically focused on innovation and creating an extraordinary health care experience for our patients and members. Sentara was named to IBM Watson Health's "Top 15 Health Systems" (2021, 2018), and was recognized by Forbes as a "Best Employer for New Grads" (2022), "Best Employer for Veterans" (2022), and "Best Employer for Women" (2020).

Mission, Purpose, and Values

• Mission - We improve health every day.
• Purpose - Sentara exists to be the trusted partner to individuals and the community in their journey to health and well-being.
• Values - People, Quality, Patient Safety, Service, and Integrity.

Sentara Healthcare Commitments

Sentara has made a commitment to its colleagues, patients, and members to:

• Always keep you safe.
• Always treat you with dignity, respect, and compassion.
• Always listen and respond to you.
• Always keep you informed and involved.

Sentara Health is an equal opportunity employer and prides itself on the diversity and inclusiveness of its close to an almost 30,000-member workforce. Diversity, inclusion, and belonging is a guiding principle of the organization to ensure its workforce reflects the communities it serves.

In support of our mission "to improve health every day," this is a tobacco-free environment.

For positions that are available as remote work, Sentara Health employs associates in the following states:

Alabama, Delaware, Florida, Georgia, Idaho, Indiana, Kansas, Louisiana, Maine, Maryland, Minnesota, Nebraska, Nevada, New Hampshire, North Carolina, North Dakota, Ohio, Oklahoma, Pennsylvania, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, Washington, West Virginia, Wisconsin, and Wyoming.