Senior Clinical Manager

Location

India | India

Job description

Sr. Clinical Manager - Value-Based Payments

Overview

Edifecs is seeking a Value-Based Payments Senior Clinical Manager who is well-versed in all aspects of value-based payment (VBP) contracting business workflows and will be able to support the expansion of the existing VBP platform in alignment with the company's strategy and goals.

What you will do:

• Work with engineers, analysts, and QA teams to deliver and implement Edifecs scalable value-based payment solutions.
• Identify and understand client's needs and challenges in implementing value-based payment models.
• You will also help Edifecs's product and engineering teams understand clients' requirements and drive product roadmaps.
• Manage backlog, sprints, and product releases.
• Solicit, interpret, and document client business requirements and alternative payment methodologies.
• Lead and coordinate the effort to verify and validate Edifecs implementation of the client's value-based payment models.
• Collaborate with Product Managers, Engineering, and Design to enhance Edifecs products to better serve customer needs.

What you will bring:

• Bachelor's or master's degree in engineering or other technology-related program preferred or equivalent experience in analysis or healthcare. Certification in Business Analysis (CBAP) and/or Healthcare (AHM 250) is a plus.
• Knowledge of value-based payments, provider contract language, healthcare utilization, US state and federal guidelines.
• Hands-on experience of clinical episode groupers bundled payments, and analytics.
• Experience with value-driven payment arrangements and healthcare financial/actuarial models.
• 6+ years of senior product management experience.
• Experience with managing junior and senior product managers, UX designers, scrum master's, and leading delivery teams.
• Experience and/or knowledge working with large volumes of health insurance claims, quality, risk, and premium data.
• Experience working with a value-based care strategy and implementation with payers or providers.
• Proven ability to use research and data to build products and understand nuances from an end-user perspective.
• Good understanding of data ingestion, cleansing, and modelling processes.
• Strong focus on the user -- adept in using data and metrics to iterate on the user experience.
• A strategic thinker-- ability to shape and share a strategic vision for a product.
• Ability to liaison effectively with engineers as well as business stakeholders.
• Demonstrated ability to understand and apply company policies and procedures.

About Edifecs

Edifecs is a premier technology company serving the U.S. healthcare market that empowers its customers to transform healthcare. For over 25 years, Edifecs has provided the market-leading interoperability platform. Edifecs payer and provider customers and technology partners are driving healthcare transformation with the ability to seamlessly exchange, unify, and normalize data to derive insights and intelligence and replace friction with collaboration across all stakeholders. Edifecs' platform is the foundation to help customers overcome healthcare's biggest challenges, including accelerating the adoption of value-based payment models, securing complete and accurate care funding for alternative payment models, and fully automating prior authorization.

Edifecs offers natural language processing, machine learning, and artificial intelligence to provide deeper insights into patients, populations, and business processes. As new standards and regulations continually emerge government agencies, Edifecs is a proven partner to ensure its customers maintain 'evergreen' compliance. Edifecs customers cover 290 million lives and include 100% of national health plans, 70% of state Medicaid programs, and 94% of the lives covered by Blue Cross Blue Shield payers. The company is headquartered in Bellevue, Washington, with additional offices in Atlanta, Georgia, and Mohali, India, and has more than 1000+ employees.

We are an equal-opportunity employer and value diversity at our company. We do not discriminate on the basis of race, religion, color, national origin, gender, gender identity or expression, sexual orientation, age, marital status, or disability status. Our corporate credo of innovation, collaboration, customer-centricity, and integrity drive and inform all our actions and decisions. Please contact [HIDDEN TEXT] for more information.

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Salary