Director, Health Plan Success

This is a fully remote position, open to applicants in United States.

📋 Description

• Act as the main relationship manager for a portfolio of established contracted health plans.

• Foster and uphold trustworthy relationships with health plan executives, behavioral health leaders, clinical teams, network management, and operational stakeholders.

• Cultivate a partner-specific understanding of strategic goals, membership requirements, operational hurdles, and expectations.

• Set up communication routines including regular check-ins, quarterly business reviews, and executive-level meetings.

• Recognize and mitigate relationship risks, partner issues, and emerging opportunities.

• Oversee the success of health plan partnerships, ensuring contractual obligations, partner satisfaction, retention, and contract performance are met.

• Create power/preference charts and account success strategies that include objectives, metrics, stakeholder maps, and action items.

• Track referrals, admissions, patient engagement, clinical outcomes, utilization, and operational performance.

• Manage responses to health plan inquiries, escalations, and performance issues.

• Compile and present performance reports, conduct joint operating committee meetings, and lead quarterly business reviews.

• Convert clinical outcomes, utilization patterns, patient experience metrics, and financial implications into actionable insights.

• Showcase Flourish’s impact on hospitalizations, emergency department usage, residential treatment, and other significant outcomes.

• Identify opportunities for account growth, including geographic expansion, additional populations, new products, and broader contract scopes.

• Assist in contract renewals, amendments, and expansions while collaborating with the CEO on major commercial negotiations.

• Coordinate cross-functional teams across Patient Growth, Payer Operations, Clinical Leadership, Finance, Product, Engineering, and other areas.

• Spearhead the implementation and launch of new health plan contracts once the likelihood of execution reaches around 80%.

• Formulate implementation plans and manage claims/billing readiness, case management involvement, and member-list/data integration workstreams.

• Set up implementation milestones, assign owners, establish timelines, and define success criteria.

• Provide implementation updates to executive leadership and guarantee a smooth transition to ongoing account management.

• Develop repeatable implementation playbooks and processes.

⛳️ Requirements

• 7+ years of experience in healthcare, including substantial experience in health plan account management, payer partnerships, provider relations, client success, or a closely related area.

• Experience working directly with Medicaid managed care organizations or other health plan partners.

• Proven track record in managing intricate, high-value relationships involving multiple stakeholders.

• Strong comprehension of managed care operations, healthcare delivery, and payer-provider partnerships.

• Capability to analyze healthcare performance data, pinpoint trends, and convey actionable insights.

• Exceptional executive communication, relationship management, and presentation abilities.

• Robust project management skills, with the capacity to coordinate complex initiatives across various teams.

• Proven ability to navigate challenging partner discussions, resolve escalations, and build trust.

• High level of ownership, initiative, organization, and attention to detail.

• Strong dedication to enhancing access, quality, and outcomes in behavioral healthcare.

• Preferred: Experience with Medicaid behavioral health programs, specialty provider networks, or value-based care models.

• Preferred: Background in managing relationships with national or regional Medicaid managed care organizations.

• Preferred: Familiarity with behavioral health utilization, clinical outcomes, and healthcare cost-of-care analyses.

• Preferred: Experience in a rapidly growing, technology-driven healthcare services organization.

• Preferred: Background in supporting contract renewals, expansions, or strategic account growth.

• Preferred: Familiarity with CRM systems, account management tools, and healthcare analytics solutions.

• Must be eligible to work in the United States, as Flourish Health participates in E-Verify.

🏝️ Benefits

• 401(k)

• Paid time off

• Home office stipend

• Health insurance

• Vision insurance

• Dental insurance

• Remote work

• Additional in-person event attendance 2+ times per year