Healthfirst

The Director, Clinical Performance Optimization, is responsible for managing and improving Clinical Operations’ performance KPIs. The Director is responsible for performance optimization program development, implementation and monitoring in accordance with business needs as well as Local, State and Federal standards. This position reports to the Vice President, Clinical Operations and is considered the Subject Matter Expert (SME) and key contact for internal business leaders and stakeholders. The candidate will utilize knowledge and skills to provide services for the organization in order to develop, implement, and monitor more efficient, cost-effective business processes and strategies. This function increases the probability the organization can achieve its cost containment, quality and service improvement goals. Utilizing a wide range of state-of-the-art performance improvement methodologies including, but not limited to: statistical analysis, simulation and modeling, forecasting, quality control, operations research, human factors, and time/motion studies, this individual assists Healthfirst leadership in operating more efficiently and effectively. This role is also responsible for developing and administering performance improvement training curriculum as part of Healthfirst’s continuous improvement culture. You will work to solve operational problems and improve levels of quality, service, or productivity throughout the organization.

Responsibilities include:

·       Drive initiatives and activities to enhance performance of the department with an emphasis on efficiency and effectiveness.

·       Develops and leads a team to drive optimization across the Clinical Operations Landscape (including UM, CM, behavioral health, pediatrics, and LTC products).

·       Develop, monitor and report appropriate metrics to improve overall out comes.  This to include dashboard creation, maintenance and auditing, and business leader coaching. Metric types include compliance activities, CM and UM activities, clinical status outcomes, medical cost trend implications for CM and UM, staffing/ attrition recommendations, medical cost savings initiatives and tracking, new program design staffing models, and more.

·       Design and lead comprehensive implementation plans and performs impact analysis to identify barriers or risks to successful implementation.

·       Advocate for adoption and success of plan by establishing metrics and collaborative relationships with key stakeholders; Plan staff and vendor staff as applicable.

·       Ensure data integrity is upheld to the highest standards; collaborate with Finance, Population health, Quality, Enterprise analytics, and Delivery System teams to ensure continuity across the Organization.

·       Evaluate departmental operations with a focus on process improvement.

·       Manage portfolio of projects; inclusive of contract and benefit changes, and other related activities as assigned.

·       Establish and monitor audit process to ensure adherence to specific project goals.

·       Collaborate with Performance Improvement department, Training, Program Design, Regulatory/Compliance and other internal departments to ensure efficient implementation of change.

·       Hire, coach, and train staff to ensure smooth operations

·       Participate and represent the clinical business on business implementation of new products.

·       Additional duties as assigned

Required Qualifications:

• Master’s degree and/or BS, BA in a health care related field

• Experience in medical care management, utilization management or other healthcare management position

• Strategic thinker with strong collaboration and the ability to work effectively with a variety of internal personnel and external organizations, as warranted

• Experience in process improvement, ability to devise innovative and practical solutions to solve complex problems

• Highly creative problem solver adept at liaising between teams to drive results

Preferred Qualifications:

• Experience with complex data system(s) and reporting software such as Tableau or similar platform

• Project Management skills and capabilities

• Previous experience managing a team and desire to lead

Hiring Range*:

• Greater New York City Area (NY, NJ, CT residents): $150,800 - $230,690

• All Other Locations (within approved locations): $124,400 - $190,315

As a candidate for this position, your salary and related elements of compensation will be contingent upon your work experience, education, licenses and certifications, and any other factors Healthfirst deems pertinent to the hiring decision.

In addition to your salary, Healthfirst offers employees a full range of benefits such as, medical, dental and vision coverage, incentive and recognition programs, life insurance, and 401k contributions (all benefits are subject to eligibility requirements). Healthfirst believes in providing a competitive compensation and benefits package wherever its employees work and live.

*The hiring range is defined as the lowest and highest salaries that Healthfirst in “good faith” would pay to a new hire, or for a job promotion, or transfer into this role.

WE ARE AN EQUAL OPPORTUNITY EMPLOYER. Applicants and employees are considered for positions and are evaluated without regard to mental or physical disability, race, color, religion, gender, gender identity, sexual orientation, national origin, age, genetic information, military or veteran status, marital status, mental or physical disability or any other protected Federal, State/Province or Local status unrelated to the performance of the work involved.