Director, Medicare Clinical Strategy and Performance

Molina Healthcare•Long Beach, CA

About The Position

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. Strives toward desired operational efficiencies, and provides intensive and immersive hands-on coaching and support - ensuring full optimization of business capabilities. Participates with senior leadership to establish strategic plans and objectives. Contributes to overarching strategy to provide quality and cost-effective member care.

Requirements

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.

Nice To Haves

Demonstrated experience in strategy development in the clinical setting, ideally background in management consulting in healthcare would be preferred
Registered Nurse (RN) or other advanced clinical or medical licensure. License must be active and unrestricted in state of practice.

Responsibilities

Oversight of internal and external clinical program performance.
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.
Assesses business and operational needs for opportunities to improve efficiency, productivity, effectiveness and accuracy.
Drives process change by integrating new processes with existing ones, and communicating these changes to impacted business teams.
Uses understanding of key revenue levers, cost drivers and customer satisfaction impacts of business processes to optimize and improve business processes and productivity.
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.