Provides leadership and direction in the development, enhancement and implementation of programs.Ensures that new program development process is intertwined with all functional areas so that the organization’s short-term and long-term goals are met.Evaluates existing competencies of staff using organizational performance measurements.Encourages innovation and creative thinking in order to serve the members better and faster.
ESSENTIAL DUTIES & RESPONSIBILITIES
Uses knowledge of research and design to assist in constructing parameters in performance measurement for wellness, disease, and case management consistent with the company’s strategic direction in medical management, marketing and sales.
Develops and provides structure, policies, procedures, goals and objectives to effectively restructure existing business processes to achieve economies of scale and improved business efficiencies.
Works cooperatively with other departmental staff to evaluate the health status of the members and to gather data necessary to evaluate the specific population.
Appropriately assists with CMS reporting requirements and understands, implements, and complies with CMS regulations.
Translates needs, issues, and ideas into effective strategies and action plans.Coordinates team/project activities and schedules.Synthesizes analysis and identifies key findings.
Automates production reports to streamline processes where required.Works with users to identify critical decision steps.
Manages the program for disease management ensuring that the population is tracked and evaluated, appropriate activities are implemented, practitioners and members receive communication and that systems are in place for referrals.
Responsible for developing and executing an implementation plan with physician practices seeking out Medicare members to evaluate and make proactive recommendations of health care best practices and interventions to optimize member’s health and preserve independence.
Assures staffing levels and staff competencies are appropriate to accomplish departmental duties and responsibilites productively and efficiently.
Participates in the budgetary process at the plan level, including preparation of a departmental budget and monitoring for adherence.
Recruits, develops, and motivates staff.Initiates and communicates a variety of personnel actions including, employment, termination, performance reviews, salary reviews, and disciplinary actions.
Performs other duties as assigned.
ŘBachelor’s degree or equivalent experience.Master’s degree in a health-related field preferred.
ŘRegistered nurse preferred or equivalent (5+ years) clinical experience.
ŘDemonstrated program development experience along with project management skills.
ŘStrong strategic thinking capacity, coupled with the ability to effectively execute strategic plan and excellent communication and presentation skills.
ŘPrevious (3+ years) management experience.
ŘSignificant (7+ years) operational experience in a managed care environment.
ŘDemonstrated ability to initiate and effectively drive change.
ŘDemonstrated ability to navigate among economic, clinical, research and technology disciplines.
ŘSubstantive knowledge of managed care policy and direction.
ŘAbility to lead and motivate people to achieve agreed upon results.
DISCLAIMER:The above statements are intended to describe the general nature and level of work being performed by individuals assigned to this position.They are not intended to be construed as an exhaustive list of responsibilities, duties and skills required of personnel so classified.