Paradigm

Location: Walnut Creek, CA, USA Req Number: Req Paradigm is an accountable specialty care management organization focused on improving the lives of people with complex injuries and diagnoses. The company has been a pioneer in value-based care since 1991 and has an exceptional track record of generating the very best outcomes for patients, payers, and providers. Deep clinical expertise is the foundation for every part of Paradigm's business: risk-based clinical solutions, case management, specialty networks, home health, shared decision support, and payment integrity programs. We're proud to be recognized-again! For the fourth year in a row, we've been certified by Great Place to Work , and for the third consecutive year, we've earned a spot on Fortune's Best Workplaces in Health Care list . These honors reflect our unwavering commitment to fostering a positive, inclusive, and employee-centric culture where people thrive. Watch this short video for a brief introduction to Paradigm. We are seeking a full-time, remote Director of Budgeting and Pricing. This position is responsible for pricing accuracy and management of risk-based contract budgets and subsequent forecasts. This will be accomplished by working in collaboration with multiple teams including Clinical Operations, Provider Contracting, Bill Review, Analytics, and senior management. RESPONSIBILITIES: Manage the analysis of submitted contracts, ensuring technical and clinical accuracy. Collaborates with Directors of Clinical Solutions for contract detail clarifications. Tracks custom requirements for pricing application. Presents final recommendations to proper levels of management authority for final price approval. Completes and distributes the Contract Value Analysis (CVA) for all applicable contracts within the designated timeframes. Completes and distributes the custom invoices for all applicable contracts within the designated timeframes. Direct oversight and management of the Clinical Budget Specialist Team responsible for: Serve as a resource for Paradigm Clinical Management staff as it relates to financial liability for all provider services and other Contract-related costs. Partner with Director Clinical Solutions to manage the development of all new Contract budgets, including participation in clinical conferences. Research and document patient driven costs and provider rates that drive budget development and management. Utilize web driven and other electronic resources to identify potential costs, including use of CPT codes in the company's electronic claims adjudication system. Complete all Rate Estimation requests to include accurate documentation of known or estimated financial liability in the system. Develop relationships with providers, including preferred provider organizations (PPOs), hospitals and specialty providers, ancillary services providers, and physicians. Maintain current knowledge of regulatory, industry and contractual factors to ensure the accurate estimation of Paradigm's liability on each Contract. Collaborate with other internal departments (Contracting, Bill Review, Accounting) to address and resolve specific patient / provider issues. Collaborate with the clinical team including the Director of Clinical Solutions to determine the current and future medical/financial course and its impact to the financial forecast. Complete detailed review of clinical progress reports for key significant financial events and/or clinical confinements as well as a comprehensive review of paid claims. Update each forecast with findings/changes to include; update and confirmation of known/future service dates and expense using reference data and/or direct contract with the providers, true-up of forecast for completed services to paid claims, adjustment for future services based on changes in the clinical course of treatment. Work with the contracting department to request negotiations on interim services, and escalate issues related to outstanding confinement bills variations in paid claims estimates. Work with the Risk Analytics Team to determine trends and identify improvements that can be made to enhance the accuracy and ease of budget development and/or forecasting. Participate in high-level planning and decision-making with leadership Handle recruitment and performance evaluations. Lead, mentor, and develop staff. Participate as required in Paradigm internal staff development programs. Other duties as assigned. QUALIFICATIONS: Advanced degree in a healthcare related field. Experience - 10 years of experience in health care management emphasizing product deliverable management, business process leadership and success with multiple level client engagement. Strong working knowledge of workers' compensation systems Prior experience as Medicare Set-Aside Analyst or Life Care Planner including medical record analysis and summarization, cost projections, regulatory research and report preparation desired Must maintain current understanding of state regulations and their impact on medical care and reimbursement in the workers' compensation care market. Communication Skills - Excellent oral and written communication skills; able to present to audiences of varying levels of expertise, difference in configuration Including size, level of expertise and clinical and educational backgrounds. Leadership experience in a cross-functional environment where strong influencing, negotiating, motivating skills, and relationship building have been demonstrated Successful track record with project management Strong public speaking and presentation skills Strong verbal, written and interpersonal communication skills Strong organizational, problem solving, and analytic skills with good judgment with the ability to make timely and sound decisions. Ability to multi-task and manage multiple projects at one time Customer focus, results orientation and strong business acumen Ability to work well in a dynamic, high-paced team environment Energetic, creative, flexible, organized, detailed oriented and self-motivated Proficient in Microsoft applications including Word, Excel, PowerPoint, Visio. Paradigm Benefits: Health and wellness - We want our people to be and stay healthy, so we offer PPO, HDHP, and HMO health insurance options with Cigna and Kaiser (CA employees only). Financial incentives - Paradigm's financial benefits help prepare you for the future: competitive salaries, 401(k) matching contributions, employer-paid life and disability insurance, flexible spending and commuter accounts, and employer-matched HSA contributions. Vacation - We believe strongly that work-life balance is good for you and for our company. Our paid time off and personal holiday programs give you the flexibility you need to live your life to the fullest. Volunteer time - We want our employees to engage with and give back to their communities in meaningful ways. Full and part-time employees receive one paid day per calendar year. Learning and development: One of Paradigm's core values is expertise, so we encourage our employees to continually learn and grow. We support this in a variety of ways, including our new Learning Excellence at Paradigm (LEAP) program. Paradigm believes that fostering a diverse and inclusive workplace is central to our mission of helping more people and transforming lives. We're striving to build a culture that better reflects the society we live in and empowers our team to deliver the highest levels of compassion and care to those we serve. For us, achieving this goal requires a workforce that respectfully embraces differences and commits to positive change, creating an environment where everyone is able to bring their whole self to work. Paradigm complies with federal and state disability laws and makes reasonable accommodations for applicants and employees with disabilities. If reasonable accommodation is needed to participate in the job application or interview process, to perform essential job functions, and/or to receive other benefits and privileges of employment, please contact Leave Management at . We are an Equal Opportunity Employer and do not discriminate against any employee or applicant for employment because of race, color, sex, age, national origin, religion, sexual orientation, gender identity, status as a veteran, and basis of disability or any other federal, state or local protected class. Other details PI7293a99521ad-9209