Primary focus is to support enterprise-wide strategic initiative to drive change in the care delivery system through innovative payment, network and provider contracting approaches that improve quality, cost effectiveness and patient experience with the largest and most significant hospital systems in the market. Develops, directs, and manages the operations, care coordination systems, medical management operations, quality improvement functions and attendant processes and operations of Pay for Performance Programs (PFPPs), incentives, reimbursement approaches and coordinates initiatives across divisions within Emblem.
* Provide expertise and vision with respect to planning, development and execution of goals and objectives. Overall project manager. Oversee and evaluate team activities and functions to ensure success and achievement of financial and timeline targets. Manage resources and priorities, risk mitigation, metric management, analysis, contingency planning, and reporting.
* Collaborate with Senior Medical Management team to establish evidence-based, standardized care management, care coordination practices and care transition processes. Design intervention strategies for helping members meet their health goals, promote wellness and remain in the community (preventing unnecessary emergency care and admissions). Through information, data collection analytics and market research assist with development of quality metrics, baseline measures, targets and utilization/cost/ performance assessment tools.
* Manage relationships between partners and Plan; cultivate and maintain alliances, understand provider needs, manage satisfaction and communicate expectations.
* Support VP & SVP with programmatic administrative oversight and infrastructure development. Assemble Joint Operating Committee and Joint Workgroup, including structure, processes, documentation and membership.
* Explore service and partnership opportunities and identify new market expansion opportunities. Participate in review and assessment of provider contracts, and interface with VP/SVP and Medical Management leadership to facilitate implementations of new target populations, measures or providers.
* Bachelor's degree in Business, Finance, Health Administration or related field required
* MBA or other advanced degree preferred
* Minimum 5 - 8 years' experience in operations or program management within the healthcare industry, including five years significant leadership and management required
* Must have proven project management experience, excellent communication skills, advanced influencing capabilities, ability to analyze and resolve complex issues, and a team building work style for a fast-paced environment required
* Demonstrated process improvement, workflow, benchmarking and/or evaluation of business processes required
* Experience in healthcare with familiarity with provider payment, quality measurement and network structures required
* Intermediate level of proficiency with PC based software programs and automated database management systems required (Word, Excel, Access, PowerPoint) required
* Outstanding verbal and written communication skills required
* Requisition ID: 190EW
We are committed to leveraging the diverse backgrounds, perspectives and experiences of our workforce to create opportunities for our people and our business. We are an equal opportunity/affirmative action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, protected veteran status or any other characteristic protected by law.
Depending on factors such as business unit requirements, the nature of the position, cost and applicable laws and regulations, EmblemHealth may provide work visa sponsorship for certain positions.
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