Director, Medical Policy

Point32Health • Canton, MA

1d • $161,905 - $242,857 • Hybrid

About The Position

The Director, Medical Policy has responsibility for leading the organization’s enterprise Medical Policy department activities. The Director leads, directs and modifies business processes and operations ensuring compliance with Point32Health business rules and develops, implements, and refines systems and processes to ensure compliance with all relevant regulatory and accrediting requirements for these functional areas. The Director will demonstrate subject matter expertise in the areas of medical technology assessment and medical policy development and implementation for the organization. She/he ensures that initiatives are on schedule and within budget, and guides strategy, policies, and protocols in accordance with organizational goals. He/she is responsible to identify and oversee the analysis and implementation of process changes to improve administrative efficiencies and optimize results and value for his/her teams’ work. The Director directs teams to achieve objectives. He/she leads cross departmental and cross company initiatives, and may represent Point32Health to outside organizations, vendors and agencies related to these functions. The Director is responsible for oversight of clinical and non-clinical teams to achieve these objectives. He/she may represent the Vice President Medical Affairs to internal stakeholders, external organizations and state agencies on issues related to, medical technology, and policy and must balance a personal workload as well as supervisory responsibilitiesThe Director demonstrates the ability to make strategic/complex recommendations that reflect consideration of its impact to a broad stakeholder group, the enterprise, the three divisions and the company at large. The Director, Medical Policy can take on complicated tasks that require advanced analytic, assessment and evaluation skills and possesses strong inter-personal and leadership skills. Effective stakeholder management is a critical function of a director.

Requirements

• Valid Registered Nurse licensure
• Bachelor’s degree
• 10-12 years of experience in medical policy, utilization management or quality improvement or relevant work within a managed care or provider environment.
• Significant experience managing clinical and non-clinical staff, leading significant cross-functional high-level initiatives, directly managing business process change and working within a matrixed organization.
• 5 years of managerial experience.
• Proficiency in computer use, specifically PC-based systems including advanced word processing, database management and spreadsheets.
• Requires excellent written, oral communication and presentation skills, including experience in business writing, such as project proposals and descriptions.
• Excellent organizational skills and ability to successfully manage multiple priorities and tasks simultaneously.
• Attention to detail and the ability to accomplish smaller critical tasks of projects while maintaining a thorough understanding of the project’s larger impact on other departments, as well as implications for the company and provider network.
• The ability to establish short and long-term goals that will achieve the needs of the company; must be able to establish realistic timelines and follow-through to meet those goals within the established time parameters
• Must be able to work both independently and as part of a team.
• Must demonstrate self-direction, possess a high level of motivation and political astuteness, excellent interpersonal, teaching, decision making skills
• Must be able to work cooperatively as a team leader and member.
• Must have the ability to lead and motivate fellow employees by fostering team spirit, an attitude of cooperation, and a commitment to the projects.

Nice To Haves

• Master’s degree or equivalent work experience in healthcare administration and/or relevant field
• Project management experience preferred
• Project management experience preferred
• May need to coordinate the participation of other internal contacts to develop and or maintain programs.
• Able to navigate political issues using advanced organizational knowledge.
• Is an effective advocate for the program and negotiates/leads others both internally and externally to participate in the program.
• May be required to coach/mentor less experienced program managers and effectively lead in a matrixed environment.
• Able to instruct others in Program Management techniques.

Responsibilities

• Responsible for all initiatives, project teams and committees that support the Enterprise-Wide Medical Technology and Medical Policy team and processes.
• Ensures that appropriate key performance and outcomes measures are in place and utilized for medical policy program assessment and management.
• Actively monitors and manages quality standards through the interpretation of data and metrics.
• Leads inter-departmental projects to maximize efficiency of resources, ensure application of regulatory requirements and ensure consistency of medical policy implementation and oversight of for our products.
• Provides support to organizational project teams that require medical policy staff participation.
• Directs all existing and manages the evaluation of new requirements impacting medical policy development for all existing and futures lines of business and new acquisitions, identifying gaps and risks and developing and implementing strategies and processes to mitigate risks and gaps and ensure compliance with these requirements considering business needs.
• Leads inter-departmental projects to maximize efficiency of resources, promote consistency of application of regulatory requirements and ensure consistency of medical policies for all lines of business, as appropriate.
• Ensures appropriate department documentation and structure to support reliable departmental and interdepartmental performance and functionality
• Continually evaluates opportunities to support organizational effectiveness and priorities and marshalls dedicated work efforts to reach corporate goals and objectives
• Manages the implementation of changes required, as a result of changes in state and federal regulatory, EOHHS (Executive Office of Health and Human Services), NCQA (National Committee for Quality Assurance) accreditation or CMS requirements across the enterprise which impact Medical Policy work for all lines of business.
• Works with the government affairs and legal teams to evaluate and make recommendations regarding the impact of new regulations and legislation related to the clinical quality and medical Policy department work.
• Ensures department readiness to meet audit requirements related to any line of business
• Mentors, supervises, and trains staff to ensure each is working at his/her potential, is encouraged to develop professionally, and fosters cross training and supports adequate depth of skill mastery for successful achievement of business and professional goals.
• Leads department wide employee engagement activities and initiatives
• Responsible for team budget process, realization of department administrative budget targets and for maintaining cost effective staffing levels in collaboration with Vice President, Quality Management
• Develops a plan for training and developing a succession plan for key team roles
• Other projects and duties as assigned.

Benefits

• Medical, dental and vision coverage
• Retirement plans
• Paid time off
• Employer-paid life and disability insurance with additional buy-up coverage options
• Tuition program
• Well-being benefits
• Full suite of benefits to support career development, individual & family health, and financial health

What This Job Offers

• Job Type: Full-time
• Career Level: Director