Director Medical Expense Initiatives

LOCATION: Can sit in Atlanta, Tampa or South Carolina Offices


REPORTING TO: VP, Regional Finance

Drives improvements in market performance via the strategic oversight of quality & affordability initiatives (QAIs). Serves as a critical resource in supporting, managing and driving financial and quality strategic projects and initiatives for assigned markets. Supports shared services and market leaders in executing business strategies impacting medical expenses, revenue and quality scores.

Essential Functions:

  • Works collaboratively with a cross-functional group of market and shared services leaders to improve performance with regard to medical cost management, quality improvement and market profitable growth.
  • Ownership of QAI related market programs focused on improving market performance to ensure financial objectives, including enhanced profitability are achieved, via the execution of well-defined and implemented strategies.
  • Establishes, builds and improves strong cross-functional relationships with internal (market and corporate) departments to implement financial business strategies and imperatives.
  • Ability to lead change, drive and execute incentive programs designed to improve market performance and increasing revenue.
  • Provides project management oversight of key initiatives (e.g. QAIs).
  • In partnership with market and shared services leaders, participates in the strategic planning process and annual forecasting activities for product. Accountable for assessing market dynamics, competitive position and operational performance.
  • Advises and makes recommendations to streamline key business functions particularly as they result to quality & affordability initiatives and opportunities.
  • Performs other duties as assigned.
Additional Responsibilities:
    Candidate Education:
    • Required A Bachelor's Degree in a related field
    • Preferred A Master's Degree in a related field
    Candidate Experience:
    • Required 7 years of experience in strategic planning and development, product management, and financial management
    • Required 5 years of experience in within a health care or managed care environment
    Candidate Skills:
    • Advanced Demonstrated interpersonal/verbal communication skills
    • Advanced Demonstrated written communication skills
    • Intermediate Ability to work in a fast paced environment with changing priorities
    • Intermediate Demonstrated organizational skills
    • Intermediate Ability to lead/manage others in a matrixed environment
    • Advanced Ability to analyze and interpret financial data in order to coordinate the preparation of financial records
    • Intermediate Ability to analyze and interpret financial data in order to coordinate the preparation of financial records
    • Advanced Ability to communicate and make recommendations to upper management
    • Intermediate Ability to drive multiple projects
    • Intermediate Demonstrated negotiation skills
    • Intermediate Ability to influence internal and external constituents
    • Advanced Ability to analyze and interpret financial data in order to coordinate the preparation of financial records
    • Advanced Demonstrated problem solving skills
    • Advanced Demonstrated analytical skills
    • Advanced Other Strategic mindset and ability to balance marketplace requirements with the objectives of program
    • Demonstrated leadership skills
    Licenses and Certifications:
    A license in one of the following is required:
      Technical Skills:
      • Required Intermediate Microsoft Word
      • Required Advanced Microsoft Excel
      • Required Intermediate Microsoft PowerPoint
      • Required Intermediate Microsoft Outlook
      • Required Advanced Financial Management Systems (Generic)

        About us
        Headquartered in Tampa, Fla., WellCare Health Plans, Inc. (NYSE: WCG) focuses primarily on providing government-sponsored managed care services to families, children, seniors and individuals with complex medical needs primarily through Medicaid, Medicare Advantage and Medicare Prescription Drug Plans, as well as individuals in the Health Insurance Marketplace. WellCare serves approximately 5.5 million members nationwide as of September 30, 2018. WellCare is a Fortune 500 company that employs nearly 12,000 associates across the country and was ranked a "World's Most Admired Company" in 2018 by Fortune magazine. For more information about WellCare, please visit the company's website at EOE: All qualified applicants shall receive consideration for employment without regard to race, color, religion, creed, age, sex, pregnancy, veteran status, marital status, sexual orientation, gender identity or expression, national origin, ancestry, disability, genetic information, childbirth or related medical condition or other legally protected basis protected by applicable federal or state law except where a bona fide occupational qualification applies. Comprehensive Health Management, Inc. is an equal opportunity employer, M/F/D/V/SO.