Description and Requirements
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.