Vp Or Dir Of Health Plan Operations

About MyPlace Health

myPlace Health was founded in 2021 by mission-driven healthcare leaders and organizations that are committed to drastically improving health outcomes, quality and experience for vulnerable older adults and frail seniors. We are an integrated care delivery organization that specializes in providing personalized care and coverage to older adults who wish to remain safely living in their homes and communities for as long as possible, rather than living in a nursing facility.

Our mission is simple: to enable seniors to live the independent lives they deserve. The primary ways in which we pursue our mission are through capitated arrangements with government payers, such as Medicare and Medicaid under the PACE (Program of All-Inclusive Care for the Elderly) model, and as a value-based provider working in partnership with local health plans.

We are building a mission-driven team that shares our passion for redefining the way older adults experience care as they “age in place” in the community. This is a unique opportunity to take on one of our country’s most challenging healthcare problems and it is a unique moment in time to join us as we scale up to spread our mission across markets.

About This Role

This role presents an extraordinary opportunity for a mission-driven leader to play an integral role in establishing the finance and health plan operations of a dynamic, integrated care delivery startup. This teammate will be responsible for building, scaling, and continuously improving our Health Plan Operations function, which includes, but is not limited to, TPA management/oversight (claims), utilization management, provider network administration, and more. As one of the inaugural members of our leadership team, this teammate will set the tone in how we develop sound and efficient health plan operations that enable us to scale our model efficiently and responsibly. Most importantly, this teammate will be empowered to think strategically across nearly all aspects of our organization in support of our effort to redefine the way older adults experience care as they age in place in their homes and communities.

Expectations for this Role

• Lead utilization management operations by supporting care teams on the ground with appropriate tools and process that ensure efficient and timely decisions
• Serve as the accountable leader for our PACE Health Plan Operations function
• Communicate confidently and persuasively to all audiences, including external stakeholders
• Manage enrollment data and data systems including data transfers and the development and management of systems to meet PACE programmatic requirements
• Build, mentor, and manage teams of Associates, Managers, and other Directors
• Continuously seek improvements to processes and systems across functions as the size and complexity of our business grows
• Stay current on regulations and policies impacting the PACE program, health plan operations, and our compliance program and share that knowledge across the organization
• Lead all Medicare Part D operations, including managing PBM and pharmacy services vendors
• Manage and provide oversight to selected other external vendors related to any of the functions listed above and more, ensuring quality and adherence to protocols
• Oversee enrollment operations for Medicaid and Medicare, Medicare self-pay, and spenddown tracking
• Design and support reporting needed by the operations teams (e.g., Quality, Risk Adjustment, Utilization)
• Lead government relations with respect to our health plan operations and lead regulatory audits (e.g., 1/3rd financial audit, Part D audits, enrollment data verification, and other health plan related audits)
• Oversee risk adjustment compliance and documentation integrity oversight, including but not limited to coordinating the HOS survey
• Assist the company in ad hoc special projects, including fundraising, collaborations with external partners, vendor contracting, and other operating model decisions
• Manage and provide oversight to our TPA, PBM, pharmacy services, and other key vendors, including claims management, issue resolution, and receivables/payables
• Design and support reporting required by regulatory bodies (CMS, state) and any key vendors as needed
• Develop and maintain effective monitoring programs for claims processing, enrollment reconciliation, Med D, RAPS, and Encounter Data submissions
• Develop policies and procedures that meet applicable PACE program requirements
• Lead provider network administration, including strategic support for negotiations, managing our catalog of contracts, properly loading all contracts into required systems/vendors, and managing the provider manual

Attributes of an Ideal Candidate

• Strong understanding of health plan and healthcare provider financial funds flows and regulatory requirements, ideally in a PACE, Medicare Advantage (MAPD), or Medicare Prescription Drug Plan (PDP) organization
• An independent worker who can run down problems with relatively little direction, knows when and how to escalate effectively
• Passion and mission orientation for serving high-risk seniors and frail older adults
• Preferred 7+ years of related experience in a similar role and education concentration (e.g., certification, Bachelor’s, or Master’s) in a related field (e.g., business/MBA, accounting/CPA, finance/MS, economics, math, healthcare administration/MHA, etc.)
• Experience in corporate finance, venture-backed startups, private equity, investment banking, or other finance-focused roles in high-growth and entrepreneurial environments
• Thrives in a relatively undefined, “zero to one” environment – unafraid to “roll up your sleeves” and drive a wide-ranging set of projects, processes, and deliverables
• Meticulous attention to detail - you can build an Excel model from scratch, as well as audit and adapt existing financial models
• Expert proficiency in both MS Excel and PowerPoint required
• Prior experience building from the ground up or scaling a Finance & Accounting function at a high-growth healthcare organization preferred

Location

• Los Angeles preferred; relocation benefits offered if willing to reside in the Los Angeles metro area
• Remote with ability to travel 20%-80% based on business need, or

Your Application

Please submit your resume/CV and a short message that explains why you are interested in this role. .

Our Commitment to Diversity, Equity and Inclusion

At myPlace Health, we value the diversity of our team members, and we are committed to building a culture of inclusion and belonging. We pride ourselves to be an equal opportunity employer. People seeking employment at myPlace Health are considered without regard to race, color, religion, sex, gender, gender identity, gender expression, sexual orientation, marital or veteran status, age, national origin, ancestry, citizenship, physical or mental disability, medical condition, genetic information or characteristics (or those of a family member), pregnancy or other status protected by applicable law.

COVID-19 Vaccination Policy

At myPlace Health, we provide safe and high-quality care to our participants. To achieve this, we have implemented a mandatory vaccination policy to keep both our team members and participants safe as an essential requirement of this role. Medical and religious exemptions can be granted based upon review of proper documentation. We adhere to all federal, state, and local regulations by obtaining necessary proof of vaccination prior to employment.

Beware of Scams and Fraud

Please beware of scams that solicit interviews or promote jobs for opportunities that are not listed on our website or are not directly related to a job you applied for yourself. Please be advised that myPlace Health will never ask you for a credit card, send you a check, or ask you for any type of payment as part of consideration for employment with our company. If you feel that you have been the victim of a scam such as this, please report the incident to the Federal Trade Commission by selecting the ‘Rip-offs and Imposter Scams’ option: https://reportfraud.ftc.gov/#/ ..