Director of Account Management

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

📋 Description

• Lead the development, success, and retention of partnerships with health plans.

• Act as the primary client advocate and relationship owner for value-based health plan collaborations.

• Cultivate trusted relationships across various stakeholders within the plans.

• Grasp client strategic priorities, population health objectives, and success metrics.

• Create and uphold scalable account management procedures and playbooks.

• Promote the adoption and effectiveness of Enhanced Care Management while fostering active partnerships.

• Oversee contracted metrics, Medi-Cal/DHCS requirements, and CalAIM deliverables.

• Manage daily relationships in accordance with MSAs and contract stipulations, including SLAs.

• Enhance revenue through contract renewals, rate negotiations, and amendments.

• Formulate strategic account plans that identify risks, opportunities, and growth avenues.

• Spot upsell and cross-sell opportunities, including expansion into additional CalAIM Community Supports programs.

• Predict revenue and account health across the portfolio.

• Lead monthly or quarterly business reviews with clients.

• Monitor KPIs, SLAs, operational results, ROI, savings, quality, and growth.

• Keep track of DHCS policy and CalAIM program amendments and translate them into guidance for partners and account strategies.

• Coordinate eligibility files, claims/encounter data exchanges, and authorization workflows.

• Address enrollment discrepancies, claims denials, and encounter data rejections.

• Manage escalations when service delivery issues arise.

• Develop and present regular performance and quality dashboards.

• Collaborate with clinical, IT/data, finance, and legal teams to resolve issues related to plans.

• Escalate contract risks before they escalate into retention crises.

⛳️ Requirements

• A bachelor's degree in Healthcare Administration, Business Administration, or a related discipline is required.

• Over 10 years of experience in account management, client partnerships, or strategic client success with organizations serving health plans in government-sponsored lines of business.

• A minimum of 5 years of experience with managed Medicaid and CalAIM.

• Direct experience with Enhanced Care Management (ECM) is essential.

• Familiarity with California Integrated Care Management (CICM) and Community Supports (CS) is highly preferred.

• Experience working with health plans, value-based care organizations, health systems, and community-based provider networks, including ECM Lead Entities.

• A strong understanding of Medi-Cal managed care contracting, DHCS requirements, and CalAIM policy guides is necessary.

• Solid commercial acumen, including experience with contracts, pricing models, and margin management.

• Proven track record of managing a high-value client portfolio with measurable success in retention and partnership growth.

• Excellent interpersonal and executive communication skills.

• Working knowledge of healthcare regulatory and compliance standards, including HIPAA and other relevant requirements for payer and provider partnerships.

• Experience with CRM platforms and reporting tools; HubSpot experience is highly preferred.

• Willingness and ability to travel up to 25% for client meetings and team collaboration.

• Must reside in California.

• Must be legally authorized to work in the United States.

• Influenza vaccination is required for roles that are patient-, client-, or customer-facing.

• A background check, which may include drug testing or other health screenings, is required prior to employment.

• Identity and work eligibility verification through E-Verify upon hire.

🏝️ Benefits

• Medical, dental, and vision insurance.

• Income protection benefits.

• Flexible PTO.

• Company holidays.

• 401k.

• Access to additional wellness benefits.

• Mileage reimbursement for field roles in accordance with IRS guidelines.

• Bonus compensation.