Location: Henderson Rd, Tampa, FL 33634
Department: Health Services
Reports to: VP
Leads integration of health plan clinical programs and operations through collaboration with departmental leaders and external partners to optimize quality based clinical outcomes, utilization management metrics and client goals. This individual operates within the medical management structure as a liaison to the Clinical Services Organization for alignment of program goals and reporting on clinical and financial outcomes. This role builds consensus on program designs; facilitates feedback on clinical performance; and participates in on-going quality improvement processes.
- Collaborates with analytic teams to identify gaps in health of membership populations creating stratification of cohorts for outreach and intervention.
- Develops actionable dashboards measuring population health improvements. Delivers reports to internal stakeholders for evaluation, feedback and influence on program development or change.
- Through population health management strategic approaches develops and monitors deployment and performance of clinical programs (i.e. maternity program, complex care program, critical gaps in Care programs, LTSS program, etc.)
- Leads initiative based business and clinical program owners in assessment of program performance and improvement strategies.
- Evaluates program design and deployment plans for adherence to regulatory or contractual requirements.
- Maintains knowledge of competitive activity and program designs.
- Communicates to accreditation and delegation stakeholders program design, implementation status and performance metrics, as well as, quality improvement project details.
- Works with local Medical Directors and network leadership to establish healthy provider relationships and communication channels.
- Provides an external voice within key industry groups on integrative health programs.
- Perform other duties as assigned.
- Solid understanding of statistical analyses, clinical study methodologies and outcome based measures
- Strong leadership skills
- Required: Bachelor's Degree in a related field
- Preferred: Master's Degree in a related field (MPH, MBA, PhD, or MD)
- Required: 5 years of management experience in a Healthcare or managed care setting
- Required: 5 years of experience in clinical program design, implementation and/or accreditation, or quality management oversight
- Required: 5 years of experience in Medicare and Medicaid benefit designs
- Required: 5 years of experience in business plan development, written and verbal presentations
- Ability to communicate and make recommendations to upper management
- Demonstrated written communication skills
- Intermediate Demonstrated analytical skills
- Demonstrated time management and priority setting skills
- Ability to influence internal and external constituents
- Ability to implement process improvements
- Ability to work in a fast paced environment with changing priorities
- Ability to work in a matrixed environment
- Ability to lead/manage others in a matrixed environment
- Demonstrated project management skills
- Microsoft Outlook
- Microsoft Word
- Microsoft Excel
- Microsoft Visio
- Microsoft PowerPoint