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At Hill Physicians Medical Group, we’re shaping the healthcare of the future: actively managed care that prevents disease, supports those with chronic conditions and anticipates the needs of our members.
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Hill Physicians has much to offer prospective employees. We’re regularly recognized as one of the “Best Places to Work in the Bay Area” and have been recognized as one of the “Healthiest Places to Work in the Bay Area.” When you join our team, you’re making a great choice for your professional career and your personal satisfaction.
Hill Physicians Care Solutions (HPCS) is a wholly-owned subsidiary of Hill Physicians and operates under a Restricted Knox-Keene license issued by the California Department of Managed Care (DMHC). HPCS handles the highly visible and fast-growing Medicare Advantage full risk line of business.
The Restricted Knox-Keene license allows HPCS to assume full risk by accepting both institutional and professional risk-based capitation payments as subcontractors to unrestricted, full-service plans. We launched our first Medicare Advantage full risk business in September 2020 with one health plan and expanded with another plan in January 2022 and now support over 10K HPCS members. Our goals are to reduce total cost of care, improve quality of care, and increase member engagement for the HPCS population that Hill Physicians manages.
Under the leadership of the Vice President, Business Strategy and Government Programs
the Director, Full Risk (HPCS) Operations is responsible for successful definition, planning, implementation, and delivery of HPCS programs that require cross-functional collaboration and input of internal teams (business, clinical, and IT) and external stakeholders (health plans, hospitals, physicians). The Director, Full Risk (HPCS) Operations will develop and lead HPCS-critical projects and programs, and related business and technology activities within the constraint of scope, quality, time, and budget.
Key Tasks and Responsibilities:

• Has oversight and/or ownership over the full risk business P&L to make sure that the HPCS its financial objectives
• Develops strategic roadmap supporting the corporate goals for HPCS line of business with clear plans, key activities, projected outcomes.
• Leads and supports the HPCS expansion strategy and implementation (e.g., add new health plan partner, expand to new regions) to position HPCS for growth.
• Lead and direct the full risk team to ensure day to day operations to ensure deliverables are met and coordinate required activities.
• Presents and prepares analysis, recommendations, plans, and outcomes of the HPCS operations performance for internal and external stakeholder meetings, Senior Leadership meetings and board meetings.
• Develops and executes programs and interventions to meet HPCS performance goals in achieving financial results, coding, utilization management, and quality performance.
• Develops and defines key measurable KPIs (e.g., HCC, STAR Rating, UM Metrics) for proactive performance monitoring and detect potential issues to resolve
• Leads and drives the monthly HPCS Ops Leadership Meeting to work with cross-functional departments to identify risks and opportunities for operational areas based on the KPIs and other metrics with identified solutions to implement.
• Maintains and builds performance reports to ensure accurate and consistent information to use for analysis and data-driven decision making for the full risk team and other internal teams.
• Builds and manages strong and efficient relationships with internal stakeholders and external stakeholders to serve as a subject matter expert (SME) on the full risk business.
• Acts as the point of contact and manage the relationship with the facility claims processing vendor to ensure they meet all operational performance and compliance requirement.
• Understands and abides by the Centers for Medicare & Medicaid Services (CMS) regulations and guidelines. Understands the competitive landscape; monitors industry trends, regulations, and provides information pertinent to the business planning.
• Understands regulatory compliance with DMHC regulations or requirements and the regulatory filing requirements through working with our legal and compliance department, contracting, accounting, claims, prior authorizations, and other functions to make sure regulatory responsibilities are met.

Qualifications and Experience:

• Bachelor's degree in business administration, healthcare administration, or related field preferred or equivalent experience. Advance degree desired.
• Five to ten years of progressive experience within a healthcare organization with significant operations experience
• A strong leader for the direct team and proven experience establishing strong relationships with internal and external stakeholders
• Proven experience leading programs/projects across multiple operational units and collaborating across diverse teams
• Strong knowledge of line of business P&Ls, hospital risk, value-based care management and oversight
• Strong verbal and written communication skills with the ability to synthesize complex data into a clear and concise presentation. This includes skills in PowerPoint presentations and the ability to synthesize information.
• Excellent analytical and problem-solving skills with the ability to connect the dots quickly and turning complex data into clear actions with solutions
• Proven experience in change management and working with all levels of management and external stakeholders

Salary Range
$139,400 - $186,050.00
Additional Information
Hill Physicians is an Equal Opportunity Employer

Job Type: Full-time

Pay: $139,400.00 - $186,500.00 per year

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