Functions as a program development manager in collaboration with Health Services business owners or cross-functional work groups in the development and implementation of efficient and effective standards, policy and procedures, workflows, and decision support systems to support ongoing improvements of clinical and administrative operations.
DEPARTMENT: Health Services
REPORTS TO: Director, Field Care Management
- Oversees the creation and implementation for programs relevant to the organization's strategic initiatives involving Health Services clinical, administrative, and operational input.
- Contemplates, designs and facilitates the development of various programs/systems, work flows, and integration efforts in alignment with corporate, market, contractual, regulatory and quality requirements.
- Acts as the content and technical subject matter expert to the operation managers and directors for key project initiatives including the development of detail work plans, setting deadlines, assigning responsibilities, and monitoring/summarizing project progress.
- Prepares strategic analysis of potential business and/or operational opportunities in relation to new business, transition of care, and MEI targets using customized solutions.
- Conducts a needs assessment and identification to ensure that the program team and other external stakeholders receive information in a timely manner.
- Prepares drafts for the Health Services clinical and operational proposals in response to RFI, RFA, RFP, and other MEI, regulatory, compliance or special interest initiatives.
- Perform other duties as assigned.
- Required a Bachelor's Degree in a related field or equivalent work experience Business, HC Management, or Nursing
- Preferred a Master's Degree in a related field Business or HC Management (MBA, MHA, MPH, MSN)
- Required 5 years of experience in direct program development, program management, and/or project management, preferably in a healthcare environment
- Preferred 2 years of experience in managed care, plus utilization management, care coordination, disease management, Medicare, Medicaid, DSNP, dual eligibles, PCMH
- Preferred 2 years of experience in design, development and implementation of health care programs across a variety of settings including: defining the eligible population, service mix, delivery system configuration and financing; integration of behavioral, clinical, social, and community health care for members with multiple chronic conditions; working with multiple state agencies and providers to coordinate services and information transfer; conducting assessments, contractual reviews, and business plans for new lines of business or service areas, including managed long-term care, care management programs, and/or the integration of the dual eligibles; applying innovative approaches to defined populations to improve access to care and social resources; assisting members/providers through the transition to medical homes.
Licenses and Certifications:
- Advanced ability to communicate and make recommendations to upper management Oral and written communication skills to effectively communicate clearly with all levels of management
- Advanced demonstrated written communication skills
- Intermediate demonstrated analytical skills
- Advanced demonstrated time management and priority setting skills
- Advanced ability to influence internal and external constituents
- Advanced ability to implement process improvements
- Advanced ability to work in a fast paced environment with changing priorities
- Advanced ability to work in a matrixed environment
- Advanced ability to lead/manage others in a matrixed environment
- Advanced demonstrated project management skills
A license in one of the following is required:
- Preferred Certified Case Manager (CCM)
- Preferred Certified Professional in Healthcare Quality (CPHQ)
- Required advanced Microsoft Outlook
- Required advanced Microsoft Word
- Required advanced Microsoft Excel
- Required advanced Microsoft Visio
- Required advanced Microsoft Project
- Required intermediate ability to interpret an extensive variety of technical instructions in mathematical form and deal with several abstract and concrete variables.