Managing Director, Clinical Operations - Medicare Plans (Remote)
Advantasure

New York, New York

This job has expired.


THIS POSITION CAN BE REMOTE ACROSS THE US.

SUMMARY:

This role provides day-to-day leadership and management to a multi-department health insurance services organization. Responsible for driving the Health Management organization to achieve and surpass performance metrics and business goals and objectives. Designs programs and processes which improve patient outcomes and drive down cost of care for our clients and their members. Provides timely, accurate, and complete reports on the operating condition of all assigned areas. Fosters a success-oriented, accountable environment within the organization. Supports executive leadership team in collaborative efforts related to the development and implementation of business goals and growth strategies. Motivates and leads a high performing management team. Attracts, recruits, trains, develops, coaches, and retains top talent.

RESPONSIBILITIES/TASKS:

  • Provide day-to-day leadership and direction of assigned functional areas
  • Develop, implement, monitor procedures and controls within the organization
  • Serve as a key member of the senior leadership team, handling strategic and tactical responsibilities
  • Plan, develop, organize, implement, direct and evaluate the work of functions within scope of responsibility
  • Evaluate the results of overall clinical operations regularly and systematically and reports these results to executive team
  • Support development and management of budgets for assigned areas
  • Drive accountability and authentic commitment to inclusive environment in support of objectives
  • Manage and cultivate relationships with clients, parent companies and key stakeholders
  • Work with leaders to develop innovation capabilities and resources to source ideas and drive solutions to implementation.
  • Develops policies and procedures and ensures compliance to and consistent application of regulations, contracts, policies and procedures for all assigned areas.
  • Develop and manage strategic relationships with appropriate consulting and vendor organizations.
  • Serve as a member of various leadership and advisory groups providing project guidance
  • Initiate and complete special projects as directed
DIRECTION EXERCISED:

Directly supervises exempt and non-exempt staff in accordance with company policies and applicable Federal and State Laws. Responsibilities include but are not limited to effectively interviewing, hiring, terminating, and training employees; planning, assigning and directing work; appraising performance; rewarding and counseling employees; addressing complaints and resolving problems; supporting and encouraging the engagement process.

This position description identifies the responsibilities and tasks typically associated with the performance of the position. Other relevant essential functions may be required.

EMPLOYMENT QUALIFICATIONS:

EDUCATION OR EQUIVALENT EXPERIENCE:

EDUCATION:

Bachelor's degree in human services or medical field required.

Master's or Ph.D. level degree in a medical, clinical, public health field with licensure or certification - or equivalent is preferred. Continuous learning, as defined by the Company's learning philosophy, is required.

EXPERIENCE:

Ten years of progressively more responsible executive leadership experience in a health insurance, health plan, or similar setting, with a strong background in government products and programs such as Medicare or Medicaid. Demonstrated experience leading clinical and non-clinical teams

SKILLS/KNOWLEDGE/ABILITIES (SKA) REQUIRED:
  • Leadership experience that reflects a proven track record of success.
  • Recent and related health plan, payor or business process outsource (BPO, BPaaS) experience
  • Demonstrated leadership experience with Care Management, Utilization Management, Disease Management, Medical Management, Population Health, STARS/CAHPS/HEDIS, Medical Policy, Pharmacy Operations, Appeals & Grievance, Client Relationship Management, Vendor Oversight
  • Demonstrated ability in using data driven decision making to design programs and processes which improve patient outcomes and drive down cost of care
  • Ability to lead collaboratively across many teams in a fast paced, growth-oriented environment
  • Thorough knowledge of health plans, insurance products and processes
  • Expertise with Medicare Advantage and government insurance programs
  • Ability to recognize interdependencies of process and overall impact of changes
  • Able to build a culture of trust and respect with internal and external stakeholders.
  • Excellent communication and relationship management skills.
  • Able to conceptualize and develop new ideas and opportunities for improvements, proactively assess the impact of emerging industry, economic & competitive trends
  • Knowledge of high performing team building and employee motivation theories with the ability to effectively manage employee teams across multiple locations.
  • Ability to appropriately manage resources, budgets, issues, and risks for the successful completion of business goals
  • Excellent oral and written communication, as well as presentation skills.
  • Ability to anticipate business needs and implement processes and products that support them
  • Ability to establish rapport and maintain customer satisfaction without compromising priorities.
  • Ability to interact with others at all levels of the organization, to build consensus and drive objectives to completion
WORKING CONDITIONS:

Work is performed in an office setting with no unusual hazards. Travel is required

The qualifications listed above are intended to represent the minimal skills and experience levels associated with performing the duties and responsibilities contained in this position description. The qualifications should not be viewed as absolute standards, but as general guidelines that should be considered with other position-related criteria.

We are an Equal Opportunity Employer. Diversity is valued and we will not tolerate discrimination or harassment in any form. Candidates for the position stated above are hired on an \"at will\" basis. Nothing herein is intended to create a contract.


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