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Functions as a program development manager in collaboration with Quality, Health Services and Operations business owners or cross-functional work groups in the development and implementation of efficient and effective standards, policy and procedures, work flows, and decision support systems to support ongoing improvements of clinical and administrative operations.
Oversees the creation and implementation of programs relevant to the organization's strategic initiatives involving Health Services, clinical and operational quality administration.
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 detailed work plans, facilitating route cause analysis, identifying and socializing process enhancements, 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 needs assessments and identification to ensure the program teams and other external stakeholders receive information in a timely manner.
Partners with leaders and members of the Quality Analytics and Improvement Teams and determines data needs as well as assists in designing tools and reports as necessary
Leads clinical and operations staff with consulting and analysis services to support initiatives intended to achieve breakthrough or incremental process improvement in patient quality of care
Conducts other responsibilities as needed.
Additional Responsibilities:Candidate Education:
Required A Bachelor's Degree in a related field
Required 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
Required 5 years of experience in managed care, plus utilization management, care coordination, disease management, Medicare, Medicaid, DSNP, dual eligibles, PCMH
Required 2 years of experience in design, develop and implement STARS, CAHPS, HEDIS and other enterprise quality related 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 market leaders to coordinate consistent quality initiatives; conducting assessments, contractual reviews, and business plans for new quality improvement, including internally sourced or vendor sourced quality programs, and/or the integration of innovative approaches to defined programs to improve quality ratings company wide.
Advanced Ability to communicate and make recommendations to upper management
Advanced Demonstrated written communication skills
Advanced 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: