Company :
EndorsedJob Description :
JOB SUMMARY
This job is responsible for clinical value initiatives that lower medical spend and improve quality within assigned business unit. The incumbent will also be responsible for clinical client or provider performance management. Is accountable for the identification of high cost trends, as well as the execution, and value realization of strategic actions aimed at improving the health of the population and reducing cost. The incumbent is accountable for the development of strategic direction for value creation and management of the day-to-day operation including analysis of data and identification of trends, execution of solutions to address root cause issues, ongoing monitoring of solution effectiveness and adjustment of solutions as needed. Oversees the client or provider performance programs which include Cross Functional Owners (indirect, matrix reports) and will support in the identification, design, and execution of trends and solutions. Accountable for driving revenue value through a comprehensive risk assessment function as applicable.
ESSENTIAL RESPONSIBILITIES
Perform management responsibilities to include, but are not limited to: involved in hiring and termination decisions, coaching and development, rewards and recognition, performance management and staff productivity. Plan, organize, staff, direct and control the day-to-day operations of the department; develop and implement policies and programs as necessary; may have budgetary responsibility and authority.
Serves as a liaison/engage with sales team partners to ensure performance guarantees are appropriate, achievable and staffing impacts/value tradeoffs are objectively understood.
Lead Start-up/onboarding of Product buy-up programs that will be supported by the business unit, Collaborate with sales and product during the design process related to buy-ups to ensure design is achievable and will deliver value; ongoing management of program metrics.
Development, onboarding/launch of new clinical initiatives that promote clinical performance and are aligned to cost reduction or client program performance.
Coordinate and align resources, training, technologies and processes to achieve medical cost reduction targets and the Organization's strategic goals. Support the execution of financial analysis and data analytics processes that enable the team to identify ways to reduce medical cost spend and meet the Organization's strategic targets. Use analytics to drive decision making and prioritizing.
Produce a communication strategy to ensure all internal stakeholders are aware of their action items and are held accountable. Execute on the communication strategy. Consistent management across all value and program based targets at regular cadence in coordination with Business Planning and Performance.
Other duties as assigned or requested.
EDUCATION
Required
Bachelor's Degree
Substitutions
6 years of related and progressive experience in lieu of Bachelor's degree
Preferred
Master's Degree
EXPERIENCE
Required
7 years in Health Insurance Industry OR Clinical Programs OR Clinical Services
To Include
5 years in a management role
3 years with medical cost management
Preferred
None
LICENSES or CERTIFICATIONS
Required
None
Preferred
None
SKILLS
Influence and Persuasion
Collaborative Problem Solving
Leading Change
Conflict Management
Presentation Skills
Business Transformation
Developing People
Delegation
Process Improvement
Stakeholder Management
Language (Other than English):
None
Travel Requirement:
0% - 25%
PHYSICAL, MENTAL DEMANDS and WORKING CONDITIONS
Position Type
Office-based
Teaches / trains others regularly
Frequently
Travel regularly from the office to various work sites or from site-to-site
Occasionally
Works primarily out-of-the office selling products/services (sales employees)
Never
Physical work site required
Yes
Lifting: up to 10 pounds
Constantly
Lifting: 10 to 25 pounds
Occasionally
Lifting: 25 to 50 pounds
Rarely
Disclaimer: The job description has been designed to indicate the general nature and essential duties and responsibilities of work performed by employees within this job title. It may not contain a comprehensive inventory of all duties, responsibilities, and qualifications required of employees to do this job.
Compliance Requirement: This job adheres to the ethical and legal standards and behavioral expectations as set forth in the code of business conduct and company policies.
As a component of job responsibilities, employees may have access to covered information, cardholder data, or other confidential customer information that must be protected at all times. In connection with this, all employees must comply with both the Health Insurance Portability Accountability Act of 1996 (HIPAA) as described in the Notice of Privacy Practices and Privacy Policies and Procedures as well as all data security guidelines established within the Company’s Handbook of Privacy Policies and Practices and Information Security Policy.
Furthermore, it is every employee’s responsibility to comply with the company’s Code of Business Conduct. This includes but is not limited to adherence to applicable federal and state laws, rules, and regulations as well as company policies and training requirements.
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