Start a career you'll love with eternalHealth!

eternalHealth – Your Forever Partner in Healthcare and Beyond

Healthcare is confusing, but it doesn’t need to be. A consumer-centric HMO based in Boston, MA, we are a tech-focused start up that is committed to creating long-lasting partnerships with our members, our providers, and you!

About the role: As a Broker Support and Sales Operations with eternalHealth you will have a hand in creating a marketing and sales strategy that effectively communicates our mission, values and differentiated product. Working with external vendors such as graphic designers, call centers, and brokers you will have multiple external-facing opportunities to build relationships and build a robust, local and sustainable marketing strategy.

We provide a unique opportunity to be a part of a health plan in its beginning stages. By taking advantage of this rare opportunity, you will be able to gain insight into all the operations and expertise that is required to run a successful and sustainable plan. Our team members are flexible and able to play different roles, while staying committed to teamwork and collaboration, and being passionate about sustainable change.

Responsibilities:

• Support complete broker onboarding process from end-to-end.
• Support broker email blasts and special events.
• Help resolve any broker commission issues.
• Work closely with senior management team on all broker relations matters.
• Participate in the customer acquisition journey by developing strategies to market, nurturing leads, and ultimately increasing membership and retention.
• Work with the Marketing Team to create and implement targeted marketing strategies including advertisements, member events, promotional cycles, and product placement.
• Use data to produce actionable insights to further refine and pivot our marketing and sales strategies.
• Maintain strict privacy and confidentiality in accordance with eternalHealth’s security standards.
• Develop an understanding of the business across workstreams to be a fully flexible team player.
• Outreach specifically within targeted Massachusetts communities to promote brand awareness and local member engagement.
• Other duties as assigned.

Requirements:

• Bachelor’s degree in relevant field of study (e.g., Business Administration, Marketing, Sales, Communications, Public Relations, etc.)
• Must have insurance brokers license valid in Massachusetts or committed to obtaining within first three (3) months of hire.
• Strong technical skills, including with Microsoft Suite (Excel, PowerPoint, Project, etc.) and other design tools, such as Photoshop, Lightroom, Illustrator.
• Excellent written and communication skills.
• Creative, strategic, and continuously striving for improvement.
• Flexible and able to ramp-up quickly on different projects to support the team as needed in a fast-paced start-up environment.
• Ability to think outside the box and offer creative and compliant solutions to existing and new problems.

Preferred:

• Experience in marketing and sales, and/or in start-ups, tech, healthcare or insurance is a plus.
• Experience with healthcare operations is a plus.

Working with eternalHealth: eternalHealth is an Equal Opportunity Employer which means that we are committed to upholding discrimination-free hiring practices. As a woman-led company, and one committed to diversity at all levels we strive for an organization of inclusion and acceptance. We are changing healthcare for the better, starting with our own diverse and passionate teams. As an eternalHealth employee you will be empowered to contribute to our teams and strategy, regardless of previous healthcare experience. Our valued team members are encouraged and expected to offer new solutions and creative input, all while keeping in line with eternalHealth’s mission, values, and compliance standards.

Accommodations: Any eternalHealth applicant will be considered based entirely on their individual qualifications. Should you require reasonable accommodations during the application process, please contact us separately, email HR@eternalhealth.com with the email subject “Reasonable Accommodations – Applicant Name Here”.

eternalHealth – Your Forever Partner in Healthcare

Healthcare is confusing, but it doesn’t need to be. As a consumer-centric HMO based in Boston, MA, we are a tech-focused start-up that is committed to creating long-lasting partnerships with our members, our providers, and you!

About the role: As the Director of Compliance with eternalHealth you will work to support our Chief Compliance Officer in the creation and maintenance of eternalHealth’s compliance program, to ensure compliance with internal quality standards as well as applicable regulatory requirements. You will have the opportunity to work across workstreams and engage your fellow teammates to ensure a culture of compliance at eternalHealth. You will also help identify and remediate any instances of non-compliance.

We provide a unique opportunity to be a part of a health plan in its beginning stages, by taking advantage of this rare opportunity, you will be able to have insight into all the operations and expertise that is required to run a successful and sustainable plan, as well as have a hand in the development of a culture of compliance. Our team members are flexible and able to play different roles, while staying committed to teamwork and collaboration, and passionate about sustainable change.

Responsibilities:

• Develop and implement compliance policies, procedures, and practices that comply with applicable laws and regulations.
• Monitor changes to regulations to ensure that the organization remains up-to-date and compliant writing and revisions policies and procedures, developing, and conducting training, and engaging with internal and external auditors.
• Lead the compliance program training and education program.
• Monitor the organization’s exclusions and monitoring program.
• Collaborate with cross-functional teams to identify and mitigate risk.
• Conduct compliance program effectiveness reviews.
• Communicate compliance program activities to senior leadership and the governing board.
• Oversight of delegated entities to ensure compliance with applicable regulations and laws.
• Escalation of identified issues including coordination with business owners on the development and implementation of effective corrective measures.
• Assist the Chief Compliance Officer with administering the compliance audit and monitoring program.
• Supervision and management of compliance staff to ensure adequate performance in supporting the needs of the business.
• Other duties as assigned.

Requirements:

• Five (5) years of directly applicable experience in the healthcare delivery system.
• Bachelor’s degree in business, Healthcare Administration, Legal, Finance/Accounting or related field of study from an accredited college or university.
• Excellent written and communication skills.
• Creative, strategic, and continuously striving for improvement.
• Flexible and able to ramp-up quickly on different projects to support the team as needed in a fast-paced start-up environment.

Preferred:

• Professional certifications such as Certification in Healthcare Compliance (CHC), Certified Information Privacy Professional (CIPP), Certified Compliance and Ethics Professional (CCEP), Certified in Healthcare Privacy Compliance (CHPC) or similar are preferred.

Working with eternalHealth: eternalHealth is an Equal Opportunity Employer which means that we are committed to upholding discrimination-free hiring practices. As a woman-led company, and one committed to diversity at all levels, we strive for an organization of inclusion and acceptance. We are changing healthcare for the better, starting with our own diverse and passionate teams. As an eternalHealth employee you will be empowered to contribute to our teams and strategy, regardless of previous healthcare experience. Our valued team members are encouraged and expected to offer new solutions and creative input, all while keeping in line with eternalHealth’s mission, values, and compliance standards.

Accommodations: Any eternalHealth applicant will be considered based entirely on their individual qualifications. Should you require reasonable accommodations during the application process (which may include a job-related assessment) please contact us separately at HR@eternalhealth.com

Workplace: In-market location

eternalHealth – Your Forever Partner in Healthcare and Beyond

Healthcare is confusing, but it doesn’t need to be. eternalHealth is a a consumer-centric, start-up Medicare Advantage Health Plan based in Boston. We are committed to creating long-lasting partnerships with our members, our providers, and you!

About the role: As Director of Sales, you will help create and then drive the sales strategy that effectively brings eternalHealth products and services to market. Leading the internal sales team, external resources such as call centers and brokers, and partnerships with our providers, you will manage all sales channels to educate and sell Medicare Advantage services, achieve membership growth objectives, and launch eternalHealth into new markets.

This role presents a unique opportunity to participate in building a Medicare Advantage plan as it expands. In addition to leading all sales efforts, the successful candidate will work closely with other leadership team members to collaboratively innovate, solve problems, and create the roadmap for success. This is a role where you can work within an existing structure but have flexibility to make and suggest the necessary changes to build a strong and successful sales department.

Responsibilities:

• Collaborate with other members of the leadership team to set strategy and goals for sales and retention.
• Develop strategies to successfully enter new markets and achieve sales goals.
• Oversee all sales channels, including field sales, omni-channel telesales, brokers/FMO, and provider partnerships.
• Develop, monitor, and utilize productivity/key performance metrics to drive results and identify risks and opportunities across all sales channels.
• Identify, share, and drive adoption of best practices to optimize results.
• Serves as a subject matter expert on all aspects of the sales operation.
• Proactively lead, motivate, coach and manage the sales team to ensure that performance goals are met and exceeded.
• Ensure that sales across all channels are achieved compliantly, including maintaining an understanding of related CMS rules and guidelines.
• Monitor industry trends to identify innovative ways to enhance performance.
• Lead the team to build and develop core competencies and oversight around the sales process, sales management, and information management processes.
• Ensure agents are appropriately onboarded, contracted, and supported across their lifecycle. This includes licensing/appointment, certification, training, enrollment administration, commission payment, compliance, etc.
• Collaborate with Marketing Director to create and implement targeted go to market strategies, including brand and direct response advertising, member and sales events, promotional, and provider marketing.
• Develop budget and manage costs relative to approved budget for the sales department.
• Ensure that the leadership team is informed about major service issues, member concerns and other relevant business issues.
• Maintain strict privacy and confidentiality in accordance with eternalHealth’s security standards.
• Developing an understanding of the business across workstreams to be a fully flexible team player.
• Other duties as assigned.

Requirements:

• Bachelor’s degree in relevant field of study (e.g., Business Administration, Marketing, Sales, Communications, Public Relations etc.)
• Must have insurance brokers license valid in Massachusetts (resident or non-resident) or commitment to obtain non-resident license in Massachusetts and other states as necessary.
• 7+ years in sales team management roles successfully selling in the Medicare Advantage market.
• Mission focused, strong leader with excellent interpersonal skills.
• Excellent written and communication skills.
• Strong technical skills, including with Microsoft Suite – Excel, PowerPoint, Project, etc.
• Flexible and able to ramp-up quickly on different projects in order to support and lead the team as needed in a fast-paced start-up environment.
• Ability to think outside the box and offer creative and compliant solutions to existing and new problems.

Preferred:

• Experience in marketing and sales, and/or in start-ups, tech, healthcare or insurance is a plus.
• Experience with healthcare operations is a plus.

Working with eternalHealth: eternalHealth is an Equal Opportunity Employer which means that we are committed to upholding discrimination-free hiring practices. As a woman-led company, and one committed to diversity at all levels we strive for an organization of inclusion and acceptance. We are changing healthcare for the better, starting with our own diverse and passionate teams. As an eternalHealth employee you will be empowered to contribute to our teams and strategy, regardless of previous healthcare experience. Our valued team members are encouraged and expected to offer new solutions and creative input, all while keeping in line with eternalHealth’s mission, values, and compliance standards.

Accommodations: Any eternalHealth applicant will be considered based entirely on their individual qualifications. Should you require reasonable accommodations during the application process, please contact us separately, email HR@eternalhealth.com with the email subject “Reasonable Accommodations – Applicant Name Here”.

eternalHealth – Your Forever Partner in Healthcare and Beyond

Healthcare is confusing, but it doesn’t need to be. A consumer-centric HMO based in Boston, MA, we are a tech-focused start up that is committed to creating long-lasting partnerships with our members, our providers, and you!

About the role: We are seeking an experienced and detail-oriented Financial Controller to join our team at our rapidly growing health insurance company. The successful candidate will be responsible for managing all aspects of financial management, including corporate accounting, regulatory and financial reporting, budget and forecasts preparation, statutory and GAAP reporting as well as development of internal control policies and procedures. Reporting to the Chief Financial Officer, the Financial Controller will also manage the relationships with outside vendors and regulatory organizations.

We provide a unique opportunity to be a part of a health plan in its beginning stages, and you will have insight into all the operations and expertise that is required to run a successful and sustainable plan as well as build the foundation for the sustainable growth that will be crucial to eternalHealth’s success. Our team members are flexible and able to play different roles, while staying committed to teamwork and collaboration, and passionate about sustainable change. Key

Responsibilities:

• Oversee all accounting activity for the company.
• Provide leadership to financial department staff, including the Senior Accountant and Account Payable Specialist roles.
• Prepare and analyze monthly, quarterly, and annual reports to ensure financial information has been recorded and reported in compliance with established policies and procedures.
• Coordinate and direct the preparation of financial forecasts and report variances.
• Develop and document business processes and accounting policies and procedures, to maintain and strengthen internal controls.
• Prepare timely and detailed reports on financial performance on a monthly, quarterly, and annual basis.
• Prepare financial reports according to both GAAP and STAT accounting principles and explain differences to regulatory bodies and internal leadership.
• Collaborate with external auditors and strengthen & manage internal controls.
• Comply with local, state, and federal government regulatory and reporting requirements.
• Provide staff support to the company’s Audit – Finance Committee.
• Liaise with Board members, presenting financial information in an understandable and actionable manner.
• Provide input and support to other key business functions that affect the company’s financial performance, e.g., risk adjustment program, CMS bid process, etc.
• Maintain strong, positive relationships with federal and state regulators.
• Other duties as assigned.

Requirements:

• Bachelor’s degree in Finance, Accounting or related field. A Master’s degree or Certified Public Accountant (CPA) certification would be preferred.
• Proven experience as a Financial Controller or relevant role, within the health insurance sector.
• In-depth knowledge of GAAP and STAT accounting principles, and general risk management practices.
• Excellent knowledge of data analysis and forecasting methods.
• Proficient in the use of MS Office and financial management software.
• Ability to manage, guide, and lead employees to ensure appropriate financial processes are being used.
• Highly analytical, with a strong numerical aptitude and problem-solving skills.
• Strong interpersonal and communication skills.
• Ability to work on-site full-time at eternalHealth’s downtown Boston office.

Working with eternalHealth: eternalHealth is an Equal Opportunity Employer which means that we are committed to upholding discrimination-free hiring practices. As a woman-led company, and one committed to diversity at all levels, we strive for an organization of inclusion and acceptance. We are changing healthcare for the better, starting with our own diverse and passionate teams. As an eternalHealth employee you will be empowered to contribute to our teams and strategy, regardless of previous healthcare experience. Our valued team members are encouraged and expected to offer new solutions and creative input, all while keeping in line with eternalHealth’s mission, values, and compliance standards.

Work Environment: This job operates in a professional office environment. This position routinely uses standard office equipment.

Accommodations: Any eternalHealth applicant will be considered based entirely on their individual qualifications. Should you require reasonable accommodations during the application process (which may include a job-related assessment) please contact us separately; email HR@eternalhealth.com with the email subject “Reasonable Accommodations – Applicant Name Here”.

eternalHealth – Your Forever Partner in Healthcare

Healthcare is confusing, but it doesn’t need to be. eternalHealth is a consumer-centric, Medicare Advantage Health Plan. We are committed to creating long-lasting partnerships with our members, our providers, and you!

About the role: As a Provider Engagement Representative with eternalHealth you will be supporting the end-to-end process of building and maintaining a high-quality provider network. This includes supporting ongoing growth, resolving provider issues as assigned and the day-to-day management of our provider network. A high performing provider network is a critical component of our success, and our relationships with our providers are rooted in trust and transparency. In this important and valued role, you will gain insight into multiple areas of network management, from recruitment strategy to special projects to collaborating with our providers on performance improvement initiatives. This external facing role will provide the opportunity to fully understand and communicate eternalHealth’s value proposition to our provider partners.

We provide a unique opportunity to be a part of a health plan in its beginning stages. By taking advantage of this rare opportunity, you will have insight into the operations and expertise that is required to run a successful and sustainable plan. Our team members are flexible and able to play different roles, while staying committed to teamwork and collaboration, and passionate about sustainable change.

Responsibilities:

• Manages network performance for assigned territory through a consultative/account management approach
• Respond to and resolve provider issues in an efficient manner. Coordinate with other departments and teams as necessary to achieve resolutions.
• Perform site visits with assigned provider groups on a regular basis.
• Maintain regular phone and/or video check-ins with providers in assigned territories.
• Assists in evaluating provider performance and developing strategic plans to improve performance.
• Drive provider performance improvement to optimize revenue, meet quality goals, support care coordination of patients, and provide performance metrics to all VBC contracts through an established process.
• Support the development of provider network through sourcing and contracting with providers, as assigned.
• Assist with provider credentialing needs.
• Support provider communication needs, including but not limited to provider education, training, and information about eternalHealth products and strategy.
• Educate providers on eternalHealth processes and resources.
• Proactively elicit provider feedback to improve their overall experience with the Plan.
• Continuously work to understand the market and needs of our local providers.
• Support special projects as assigned.
• Be able to communicate our brand, values, and differentiators effectively and accurately.
• Maintain strict privacy and confidentiality in accordance with eternalHealth’s security standards.
• Other duties as assigned.

Requirements:

• Bachelor’s degree in relevant field of study (e.g. Healthcare administration, human services, public health, psychology/sociology, social work) or 5+ years of equivalent work experience.
• Minimum 2-3 years of experience in managed healthcare, provider-facing role preferred.
• Experienced in value-based care models preferred.
• Strong technical skills, including with Microsoft Suite and other collaborative tools.
• You’re a relationship builder and customer service focused.
• Ability to communicate value-propositions in a sales-forward role.
• Effectively communicate needs, process improvements and wins, with your network team and C-Suite officers.
• Managerial and analytical skills to manage eternalHealth software and hardware.
• Excellent written, negotiation, and communication skills.
• Creative, strategic, and continuously striving for improvement.
• Ability to present information to audiences of various skill levels.
• Flexible and able to ramp-up quickly on different projects to support the team as needed in a fast-paced start-up environment.
• Ability to think outside the box and offer creative and compliant solutions to existing and new problems.
• Strong organizational skills and attention to details to handle multiple tasks, short deadlines, frequent interruptions, and shifting priorities in support of changing company objectives Current driver’s license and reliable transportation.

Working with eternalHealth: eternalHealth is an Equal Opportunity Employer which means that we are committed to upholding discrimination-free hiring practices. As a woman-led company, and one committed to diversity at all levels, we strive for an organization of inclusion and acceptance. We are changing healthcare for the better, starting with our own diverse and passionate teams. As an eternalHealth employee you will be empowered to contribute to our teams and strategy, regardless of previous healthcare experience. Our valued team members are encouraged and expected to offer new solutions and creative input, all while keeping in line with eternalHealth’s mission, values, and compliance standards.

Accommodations: Any eternalHealth applicant will be considered based entirely on their individual qualifications. Should you require reasonable accommodations during the application process (which may include a job-related assessment) please contact us separately at HR@eternalhealth.com

eternalHealth – Your Forever Partner in Healthcare and Beyond

Healthcare is confusing, but it doesn’t need to be. A consumer-centric HMO based in Boston, MA, we are a tech-focused start up that is committed to creating long-lasting partnerships with our members, our providers, and you!

About the role: As a RN Clinical Operations Manager with eternalHealth you will be a core member at eternalHealth – whose responsibilities will include care management. This position will work towards meeting financial and operational performance goals and standards.

We provide a unique opportunity to be a part of a health plan in its beginning stages, and you will have insight into all the operations and expertise that is required to run a successful and sustainable plan as well as build the foundation for the sustainable growth that will be crucial to eternalHealth’s success. Our team members are flexible and able to play different roles, while staying committed to teamwork and collaboration, and passionate about sustainable change.

Responsibilities:

• Collaborate on day-to-day clinical operations of the health plan, including complex care management, care coordination, disease management, and transition of care.
• Work on member- and provider-based interventions to improve quality and outcomes of care and reduce avoidable costs.
• Develop and refine clinically related compliance reporting and auditing activities.
• Work with a high performing team of clinical and non-clinical professionals that will deliver exceptional care while meeting quality and delivery targets.
• Follow eternalHealth’s strategic goals related to population health management and quality improvement, including setting and following the direction for analytics and existing quality measures.
• Interact regularly with executive team and department heads to develop and execute upon eternalHealth’s overall company direction and goals, including KPIs related to cost, quality, operations, and outcomes of member care.
• Ensures applicable Medicare (and any other LOB such as Mass Connector)requirements for clinical services activities and reporting are met.
• Must understand and maintain confidentiality of business information, including Protected Health Information (PHI), as required by HIPAA and company policy.
• Comply with all guidelines established by the Centers for Medicare and Medicaid (CMS) and Massachusetts Department of Insurance (DOI) and guidelines set forth by other regulatory agencies, where applicable, and defined in eternalHealth policies.
• Excellent written and communication skills.
• Creative, strategic, and continuously striving for improvement.
• Flexible and able to ramp-up quickly on different projects to support the team as needed in a fast-paced start-up environment.
• Ability to think outside the box and offer creative and compliant solutions to existing and new problems.
• Other duties as assigned.

Requirements:

• Active RN License
• 3+ years of work experience in care management.
• Interpersonal skills with the ability to work in a fast-paced environment and health plan as an independent contributor with little supervision or as an active team member depending on the situation and needs.
• Strong technical skills, including with Microsoft Suite (Excel, PowerPoint, Project, etc.) and other collaborative tools.
• Experience coordinating with cross-functional teams and/or external partners/stakeholders.
• Ability to work on-site at eternalHealth’s downtown Boston office.

Preferred:

• Bachelor’s degree in Nursing or applicable experience.
• Master’s degree in business administration, healthcare administration, related field, a plus. Or applicable experience in a clinical or managed care environment.
• 1+ years of Health Plan experience.
• Experience in program management and/or design or implementation
• Have knowledge around industry best practices and regulatory compliant reporting. 

Working with eternalHealth: eternalHealth is an Equal Opportunity Employer which means that we are committed to upholding discrimination-free hiring practices. As a woman-led company, and one committed to diversity at all levels, we strive for an organization of inclusion and acceptance. We are changing healthcare for the better, starting with our own diverse and passionate teams. As an eternalHealth employee you will be empowered to contribute to our teams and strategy, regardless of previous healthcare experience. Our valued team members are encouraged and expected to offer new solutions and creative input, all while keeping in line with eternalHealth’s mission, values, and compliance standards.

Accommodations: Any eternalHealth applicant will be considered based entirely on their individual qualifications. Should you require reasonable accommodations during the application process (which may include a job-related assessment) please contact us separately; email HR@eternalhealth.com with the email subject “Reasonable Accommodations – Applicant Name Here”.

eternalHealth – Your Forever Partner in Healthcare and Beyond

Healthcare is confusing, but it doesn’t need to be. A consumer-centric HMO based in Boston, MA, we are a tech-focused start up that is committed to creating long-lasting partnerships with our members, our providers, and you!

About the role: As a Sales Representative with eternalHealth you will have a hand in creating a marketing and sales strategy that effectively communicates our mission, values and differentiated product. Working with external vendors such as graphic designers, call centers, and brokers you will have multiple external-facing opportunities to build relationships and build a robust, local and sustainable marketing strategy.

We provide a unique opportunity to be a part of a health plan in its beginning stages. By taking advantage of this rare opportunity, you will be able to gain insight into all the operations and expertise that is required to run a successful and sustainable plan. Our team members are flexible and able to play different roles, while staying committed to teamwork and collaboration, and being passionate about sustainable change.

Responsibilities:

• Participate in the customer acquisition journey by developing strategies to market, nurturing leads, and ultimately increasing membership and retention.
• Work with the Marketing Team to create and implement targeted marketing strategies including advertisements, member events, promotional cycles, and product placement.
• Use data to produce actionable insights to further refine and pivot our marketing and sales strategies.
• Maintain strict privacy and confidentiality in accordance with eternalHealth’s security standards.
• Develop an understanding of the business across workstreams to be a fully flexible team player.
• Outreach specifically within targeted Massachusetts communities to promote brand awareness and local member engagement.
• Other duties as assigned.

Requirements:

• Bachelor’s degree in relevant field of study (e.g., Business Administration, Marketing, Sales, Communications, Public Relations etc.)
• Must have insurance brokers license valid in Massachusetts.
• Strong technical skills, including with Microsoft Suite (Excel, PowerPoint, Project, etc.) and other design tools, such as Photoshop, Lightroom, Illustrator.
• Excellent written and communication skills.
• Creative, strategic, and continuously striving for improvement.
• Flexible and able to ramp-up quickly on different projects to support the team as needed in a fast-paced start-up environment.
• Ability to think outside the box and offer creative and compliant solutions to existing and new problems.

Preferred:

• Experience in marketing and sales, and/or in start-ups, tech, healthcare or insurance is a plus.
• Experience with healthcare operations is a plus.

Working with eternalHealth: eternalHealth is an Equal Opportunity Employer which means that we are committed to upholding discrimination-free hiring practices. As a woman-led company, and one committed to diversity at all levels we strive for an organization of inclusion and acceptance. We are changing healthcare for the better, starting with our own diverse and passionate teams. As an eternalHealth employee you will be empowered to contribute to our teams and strategy, regardless of previous healthcare experience. Our valued team members are encouraged and expected to offer new solutions and creative input, all while keeping in line with eternalHealth’s mission, values, and compliance standards.

Accommodations: Any eternalHealth applicant will be considered based entirely on their individual qualifications. Should you require reasonable accommodations during the application process, please contact us separately, email HR@eternalhealth.com with the email subject “Reasonable Accommodations – Applicant Name Here”.

eternalHealth – Your Forever Partner in Healthcare and Beyond

Healthcare is confusing, but it doesn’t need to be. A consumer-centric HMO based in Boston, MA, we are a tech-focused start up that is committed to creating long-lasting partnerships with our members, our providers, and you!

About the role: As VP of Clinical Operations Care with eternalHealth you will be a core member at eternalHealth management team. The VP provides oversight for development of strategies and processes, direction of staff, and execution of clinical operational tasks. This position will work towards meeting financial and operational performance goals and standards.

We provide a unique opportunity to be a part of a health plan in its beginning stages, and you will have insight into all the operations and expertise that is required to run a successful and sustainable plan as well as build the foundation for the sustainable growth that will be crucial to eternalHealth’s success. Our team members are flexible and able to play different roles, while staying committed to teamwork and collaboration, and passionate about sustainable change.

Responsibilities:

• Leads the development and implementation of clinical operations policies and procedures. Creates and maintains a strong compliance culture with the clinical team.
• Strategically aligns the clinical program, compliance standards and financial goals and monitors quality and performance to goals on a regular basis.
• Creates a clinical operations work environment that fosters collaboration, growth and development, and a member centric focus on clinical excellence in service.
• Grow and develop a clinical team in operations, financial acumen, utilization management, risk adjustment, HEDIS and STARs program.
• Drives performance in closing HEDIS/STARS gaps, Risk Adjustment gaps, clinical program improvements.
• Manage processes to meet member population needs.
• Provide oversight of utilization management/care management health plan related delegated function reporting activities.
• Work across departments to provide support and guidance on what can be done within each department to help meet performance metrics, such as closing HEDIS/STARS gaps, RA gaps, etc.
• Help build daily practices for the Clinical Operations team that help drive key metrics.
• Help make key decisions that are driven off of data and help support Provider Relations staff, so that we can impact Cost, Quality, and STARS/HEDIS, with a boots on the ground effort.
• Participates in executive meetings to bring the clinical operation needs into alignment with business goals.
• Addresses obstacles and challenges to achieving goals proactively and adjusts operations accordingly.
• Maintains audit readiness, by ongoing training, competency assessment, audit, monitoring of metrics and corrective action.
• Oversight of UM Process, while maintaining CM/DM functions in house.
• Other duties as assigned.

Requirements:

• Master’s Degree in a health affiliated or business affiliated field.
• 8+ years of relevant professional experience required and knowledge of medical management clinical review processes.
• 5+ years of managerial experience.
• 5+ years of Medicare health plan experience.
• Comprehensive knowledge of managed care industry standards and government regulations.

Working with eternalHealth: eternalHealth is an Equal Opportunity Employer which means that we are committed to upholding discrimination-free hiring practices. As a woman-led company, and one committed to diversity at all levels, we strive for an organization of inclusion and acceptance. We are changing healthcare for the better, starting with our own diverse and passionate teams. As an eternalHealth employee you will be empowered to contribute to our teams and strategy, regardless of previous healthcare experience. Our valued team members are encouraged and expected to offer new solutions and creative input, all while keeping in line with eternalHealth’s mission, values, and compliance standards.

Accommodations: Any eternalHealth applicant will be considered based entirely on their individual qualifications. Should you require reasonable accommodations during the application process (which may include a job-related assessment) please contact us separately; email HR@eternalhealth.com with the email subject “Reasonable Accommodations – Applicant Name Here”