Executive Director

Position Description:

The Executive Director, reporting to the Board of Directors, functions as the Chief Executive Officer of PIH and is responsible for the conception, design, implementation, and day-to-day management of operations. Working with the Board of Directors and its committees, the Executive Director develops and implements all policies, procedures, and corporate objectives. The Executive Director provides oversight to all Partners In Health functions and positions including finance, provider relations, human resources, utilization/quality management, claims adjudication, member services, and management service organizations, if any, and is also responsible for the identification and active engagement of new business opportunities, including the recruitment of doctors.

Principal Responsibilities:

The following are examples, which are intended only as illustrations of the types of work and various activities performed by the position. The absence of specific statements below does not exclude those tasks from the position if the work is similar, related, or a logical assignment of the position.

• Work with the PIH Board of Directors, PIH staff, member physicians, physician billing companies, St. Bernard Hospital administrative staff, management service organizations, independent contractors/consultants, health care payors (including HMOs, PPOs, and indemnity insurance companies), State regulatory bodies, and vendors.
• Develops and negotiates all hospital and participating physician health care contracts according to established PIH policies. Completes hospital applications for health plans.
• Develops business relationships with managed care plans to enhance contracts between PIH and health care payors. Evaluates and reports on the financial performance of managed care contracts.
• Monitors the marketplace and seeks new contractual opportunities with health plans. Annually reviews hospital and PIH agreements and seeks opportunities to enhance revenue streams.
• Keeps physician offices informed of current contract status, PIH procedures, enrollee eligibility/coverage, market trends, and health plan requirements. Coordinates Annual Required Training for Staff, Board and Providers.
• Serves on all Partners in Health Committees and Hospital Committees as needed. Provides back-up coverage for functions not requiring a license or special education to training.
• Recruits, selects, trains, evaluates, and supervises the necessary staff on all matters of employment and job performance. Annually reviews and updates the Employee Handbook as needed.
• Reviews health plan gaps reports and programs text messages needed for member outreach.
• Responsible for oversight and/or performance of payroll, accounts receivable, accounts payable, general accounting, financial reporting, and statistical recordkeeping. Coordinates with contracted MSOs (if any) and providers. Ensures accounting functions meet audit standards and comply with applicable regulations.
• Establishes, monitors and ensures that financial controls, operational procedures and quality programs are in place according to PIH policies, contractual agreements and regulatory requirements. Works with the outside auditors to complete the annual audit.
• Reviews weekly EOBs and monthly capitation checks for accuracy. Provides oversight for activities delegated to Innovista.

Requirements:

• Minimum of a bachelor’s degree in health care, business administration, or related subjects, Master’s degree preferred.
• Minimum of four years in health service administration and experience with medical delivery systems, human resources, accounting, utilization management, and HEDIS. HMO and medical practice experience preferred.
• Knowledge of third-party contracting, network management, and health care delivery mechanisms.
• Working knowledge of provider credentialing, medical claims adjudication, and utilization/quality management. Understanding of patient flow and paper flow necessary for physician office practices.
• Ability to coordinate diverse opinions and integrate them into a plan of action. Ability to supervise both professional and non-professional staff.
• Financial, interpersonal, organizational, information technology, consulting, and planning skills needed.
• Demonstrated self-directed, result-oriented approach to projects. Ability to succeed in an unstructured environment.

This position is being handled directly by David Gomez Partners, Inc.

To apply, please send your resume to recruiting@davidgomezpartners.com .