Director, Medicare Clinical Strategy and Performance

Job Summary

Leads and directs a team supporting clinical performance improvement activities. Works directly with clinical leadership to develop clinical strategy that will result in year-over-year performance in cost, quality, and overall member outcomes. Responsible for continuous improvement and successful execution of clinical transformation, and performance and process improvement initiatives.

Job Duties

• Monitors performance of assigned clinical programs during each phase of program lifecycle.
• Proactively identifies improvement opportunities, manages process gaps and identifies and implements solutions with alignment from key stakeholders.
• Uses data to evaluate actual to expected program performance.
• Synthesizes and presents learnings, insights and recommendations for key stakeholders and executive leadership.
• Uses analytical skills to identify variances in expected clinical program performance, and uses problem-solving skills and business knowledge to make recommendations for process remediation or improvement.
• Utilizes a variety of complex clinical and financial data points to inform recommendations.
• Organizes and structures cross-functional teams to drive complex programs across both shared functions and market operations.
• Develops, performs and promotes interdepartmental integration and collaboration to enhance clinical services.
• Collaborates with and keeps clinical leadership within healthcare services informed of operational issues, staffing, resources, system and program needs, and presents solution action plans for issues identified.
• Drives process change by integrating new processes with existing ones through direct coaching and mentoring of impacted business teams.
• Conducts real-time technology and operational walk-throughs as an immersive coaching clinical subject matter expert, and provides interim stabilization support.
• Affirms business and operational needs for opportunities to improve efficiency, productivity, effectiveness and accuracy.
• Evaluates and modifies existing oversight programs/criteria to meet ongoing business requirements.
• Provides oversight in the designs and implementation of programs to build/improve positive relationship with vendors.
• Provides oversight, coaching, training and support to team of direct reports.
• Deep understanding of the clinical interplay of population health, value-based care, and other network strategies to drive clinical performance and care management activities.

Job Qualifications

• At least 8 years health care experience, including 6 years of managed care experience supporting clinical operations and clinical/quality improvement activities, or equivalent combination of relevant education and experience.
• At least 3 years health care management/leadership experience.
• Deep understanding of clinical operations: utilization management, care management, etc.
• Ability to provide hands-on, immersive and directed support for identified business improvement initiatives.
• Ability to work cross-collaboratively in a highly matrixed environment.
• Experience providing coaching, development and operational feedback to individuals and teams.
• Experience using business knowledge to make recommendations for process remediation or improvement.
• Strong ability to lead and achieve results.
• Strong interpersonal, consultative, organizational, tracking and follow-up skills.
• Ability to research, obtain, coordinate, and integrate feedback and directions from diverse operational groups.
• Experience working with clinical program leadership for action plan and organizational determinations.
• Excellent verbal and written communication skills.
• Microsoft Office suite/applicable software program(s) proficiency.