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WellCare - Operations Leadership Careers

Program Development - Complex Populations - Director Job

Full Job Title: Director, Program Development - Complex Populations

Job Number: 1800670

Location: Tampa, FL

Date Posted: 1-30-2018

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.

The ideal Candidate:

  • Would have taken ideas around complex populations and/or Maternal/Child, create strategy and implement across the organization.
  • Would have worked cross-functionally.
  • Would be an experienced people leader.

Essential Functions:

  • 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.
Additional Responsibilities:
  • Solid understanding of statistical analyses, clinical study methodologies and outcome based measures
  • Strong leadership skills
Candidate Education:
  • Required A Bachelor's Degree in a related field
  • Preferred A Master's Degree in a related field MPH, MBA, PhD, or MD
Candidate Experience:
  • Required 5 years of management experience Healthcare or managed care settings
  • Required 5 years of experience in Clinical program design and/or implementation and/or accreditation or quality management oversight
  • Required 5 years of experience in Knowledge of Medicare and Medicaid benefit designs
  • Required 5 years of experience in Business plan development, written and verbal presentations
Candidate Skills:
  • Advanced Ability to communicate and make recommendations to upper 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
Licenses and Certifications:
A license in one of the following is required:
Technical Skills:
  • Required Intermediate Microsoft Outlook
  • Required Intermediate Microsoft Word
  • Required Intermediate Microsoft Excel
  • Required Intermediate Microsoft Visio
  • Required Intermediate Microsoft PowerPoint

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Last Updated On: 12/9/2015