SUMMARY: This position supports Emergient including WMAHP (IA, SD), NextBlue of ND (working with Arkos), and in VBA (and now working with Arkos), including participation in 3 governance meetings including Strategic Leadership Meetings, medical policy coordination, driving and influencing strategy with plan presidents and teams, and monitoring and reporting on progress to JV partners, BCBSM/EM executives, and multiple boards of directors.
This position is also responsible for all aspects of clinical care delivery for the Emergient and is critical to the cost of care, Stars support, and Risk Adjustment support Emergient. Membership will double in size in January of 2025; membership is expected to continue to grow year over year. Additional responsibilities include: planning and execution for Emergient Clinical Value Initiative portfolio, with an emphasis on developing and maintaining multi-year planning and capabilities matrix to guide and inform capital planning process and annual budgeting.
RESPONSIBILITIES/TASKS:
In collaboration with leadership and clinicians, develop the care delivery strategy for Emergient, adjusting as necessary
Coordinates medical policy committees
Manages vendor relationships
Responsible for reviewing data and analytics
Responsible for ensuring compliance with CMS final rules pertaining to Care Delivery
Serve as the clinical program consultant for AEP activities
Manage and assist in the development of a pipeline of opportunities with the purpose of achieving clinical value (Stars, Risk Adjustment and cost of care) for Emergient
Formalize plan for delivery of multi-year initiatives to achieve clinical value and medical cost savings.
Work closely with Finance, IT, and SHS Planning and Strategy functions to ensure efforts are aligned with overall Enterprise and Emerging Markets timelines.
Lead annual efforts to support Bid submission for Senior Health Services including, but not limited to:
Initiative / capabilities planning
Actuary cost savings certification
IT and Readiness estimation
Oversee the execution of projects to achieve clinical value and medical cost savings that have significant implications for Senior Health Services strategic plan and financial targets. These projects have significant visibility with Executive leadership and require position leadership to support the following type of activities:
Facilitate executive level discussions and comfortably engage executives to support strategic and tactical objectives of the business
Drive execution of program efforts and ensures strong alignment of work efforts
Manage issue escalation and resolution
Work cross functionally across the organization to drive delivery; spokesperson and representative for the business -- supports education of business objectives, drives structure, and works behind the scenes to get alignment, proactively anticipate issues, and foster communications across teams.
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:
Bachelor's degree in a related field required. Master's degree in public health, health care administration or other related field is preferred. Valid Michigan Accident and Health Insurance License required. Valid and unrestricted driver's license required. Continuous learning, as defined by the Company's learning philosophy, is required. Certification or progress toward certification is highly preferred and encouraged.
EXPERIENCE:
Ten (10) years of progressively more responsible experience in a Business environment with demonstrated technical experience that provides the necessary knowledge, skills and abilities. Ten years of progressively more responsible industry experience in related field including consulting experience or direct experience leading and managing strategic programs valued at $50+M to the business preferred. 7 to 10 years' experience working in a health insurance plan, health provider organization, or public health or community-based agency in a similar capacity Five (5) years management or supervisory experience in Business required. Bilingual skills preferred.
SKILLS/KNOWLEDGE/ABILITIES (SKA) REQUIRED:
Ability to work effectively in a team environment.
Ability to work in time sensitive / rapid pace environment with shifting priorities and high exposure to varying levels of the Leadership team (Executive / Senior)
Understanding of the Medicare Advantage marketplace and industry trends impacting the business
Critical thinking and analytical skills; ability to take loosely formed ideas and information related to strategy and capabilities and drive formalization of related deliverables
Analytical skills -- able to support identification of data needed (e.g. numbers / facts / figures) to enhance messaging and support research (organize data, develop charts, tables, etc.)
Must demonstrate leadership ability and team building skills to effectively supervise professional and non-professional staff and interact with all levels of management.
Strong negotiation skills to influence key stakeholders.
Customer management skills.
Managerial experience / ability to lead, motivate and cultivate a junior team (including virtual management of teams)
Ability to work with and empower others on a collaborative basis (manage in a matrix) to ensure success of unit team (including virtual management of teams)
Ability to develop templates or organize data / storyboard discussion objectives and information needed
Ability to effectively exchange information, in verbal or written form, by sharing ideas, reporting facts and other information, responding to questions and employing active listening techniques.
Ability to effectively present budgetary and/or cost information and respond to questions as appropriate.
Ability to establish workflows, manages multiple projects, and meets necessary deadlines.
Ability to think cross functionally and broadly about the business
Ability to work with team of project managers supporting portfolio of initiatives
Microsoft suite with an emphasis on PPT, Excel, Word, Visio, and Project; ability to communicate and synthesize data for executive leadership review and consumption
WORKING CONDITIONS:
Work is performed in an office setting with no unusual hazards. Travel is required.
PAY RANGE:
Actual compensation decision relies on the consideration of internal equity, candidate's skills and professional experience, geographic location, market, and other potential factors. It is not standard practice for an offer to be at or near the top of the range, and therefore a reasonable estimate for this role is between $142,700 and $239,000.
The qualifications listed above are intended to represent the minimum education, experience, skills, knowledge and ability levels associated with performing the duties and responsibilities contained in this job description.
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.
