Job description
- Develop and deploy a member-centric care program strategy
- Lead the development of innovative care management models to support affordability and future operating platform strategy
- Lead the transformation of the current telephonic case management program to a mix of high touch and low touch solutions ranging from face to face to virtual engagement solutions
- Leverage the best practices of the current state to evolve in to a scalable model that addresses the needs of the future provider models (including ACO, Integrated Health Systems PCMHs)
- Customize solutions that are aligned with regional practice patterns and delivery system needs and provide appropriate monitoring evaluation and controllership to ensure desired business results are met
- Develop effective business processes to address the to address the high opportunity impactable members/population segments, disease states, episodes and delivery system solutions necessary to support Care Programs long-term strategy
- Develop effective Medicare Care Management Strategy to improve outcomes, mitigate cost trends and improve STAR ratings
- Effectively integrate care programs across the care continuum
- Align the Clinical Operations along the quality and administrative continuums to define MLR vs. non-MLR operations spend
- Lead the development and improvement of Care Program processes and performance standards
- Lead, develop, motivate and manage a high performing team to meet organizational goals and objectives while effectively managing change
- Lead the development of policies, procedures, standards and training
- Coordinate with Member Service Organization (MSO), Retail Health, Senior Business Unit and other matrix partners to seamlessly integrate member empowerment and engagement programs
- Lead the development of vendor management strategy to support Care Programs
- Ensure that the Care Program processes are aligned with the highest quality standards required by – Accreditation and Credentialing Organizations (for example, NCQA, URAC, etc.)
- Interpret financial data and trends to guide and evaluate business decisions
- Current RN license with Bachelors degree in healthcare management or related field; advanced degree preferred
- 7+ years experience in healthcare administration with progressively increasing leadership and operations positions in a large health plan
- Case Management and Disease Management experience
- Demonstrated capability in development execution of strategic initiatives
- Demonstrated track record of improving care outcomes
- Demonstrated capability in setting and delivering program goals
- Strong verbal and written communication skills
For additional information and/or confidential consideration, please contact:
CONSULTANT: Tricia French, RN, BSN
President & CEO
The French Group
757-362-0202
tfrench@frenchgroup.com
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