Program Manager, Clinical Strategy and Performance

Martin's Point Health Care-posted 9 months ago
Full-time
Houston, TX
Insurance Carriers and Related Activities
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Join Martin's Point Health Care - an innovative, not-for-profit health care organization offering care and coverage to the people of Maine and beyond. As a joined force of 'people caring for people,' Martin's Point employees are on a mission to transform our health care system while creating a healthier community. Martin's Point employees enjoy an organizational culture of trust and respect, where our values - taking care of ourselves and others, continuous learning, helping each other, and having fun - are brought to life every day. Join us and find out for yourself why Martin's Point has been certified as a 'Great Place to Work' since 2015. The Program Manager will support the development of successful Utilization and Care Management programs for Senior and Military family populations, working closely with Health Plan Clinical leadership. They will coordinate project teams focusing on utilization management, medical expense reduction, and STARS performance, using project management skills to drive clinical program development. The role also involves partnering with the Chief Medical Officer and other clinical leaders to ensure efficient execution of projects related to care management, provider engagement, and quality performance. Additionally, they will collaborate with Medical Directors and monitor program scorecards to enhance performance and collaboration across the organization.

  • Supports the strategy and program development for clinically and financially successful Utilization and Care Management programs for Senior and Military family populations.
  • Works closely with the Health Plan Clinical leadership team and provides coordination of the project teams related to Utilization and care management, Medical Expense Reduction and STARS performance.
  • Utilizes project management skills to drive timely clinical program development and enhancement, and foster collaborative programming across all levels and departments related to the clinical team across the organization.
  • Partners with and provides support to drive the Health Plan and Delivery Service Clinical Programs managed by the Chief Medical Officer and supports the CMO in management of reporting staff and associated issues and communication.
  • Works closely with other Clinical Leaders, especially in the Health Plan, to ensure projects involving utilization management, Care Management, Medical Expense, Provider Engagement and Risk Adjustment have a robust plan and meet set deadlines and deliverables.
  • Works closely with the VP of Quality to drive quality performance projects through different parts of the organization.
  • Ensures the appropriate leaders and the right team members are involved in the projects and enhance cross collaboration among other health plan departments.
  • Works with the Delivery System Medical Directors to drive enhanced collaboration with Medallion Patients and help to drive enhanced star and coding performance.
  • Creates and monitors scorecards for the direct reports and programs managed by the CMO.
  • Bachelor's degree in a clinical field of study (SW, RN, Pharmacy, etc.).
  • 10 years of experience in health care including Managed Care Medicare plan and in Medicare Line of business.
  • Experience in Project or Program management with a track record of driving new clinical programs through implementation and monitoring.
  • Experience in driving the development, implementation and management of a health plan clinical program strategy, design, redesign, clinical platform conversions, implementation, and evaluation in strong partnership with the Clinical Lead.
  • Experience using data and data analysis to design and monitor programs and manage success, including ROI, of programs.
  • Experience in Medicare Advantage and TRICARE preferred.
  • Experience in evaluating financial and clinical performance metrics.
  • Expert knowledge in the use of Microsoft tools.
  • Ability to influence decision-making at various organizational levels.
  • Demonstrated expertise in designing and implementing clinical programs with measurable outcomes.
  • Ability to translate strategic objectives into operational execution plans.
  • Understanding of healthcare cost containment strategies and risk-based contracting.
  • Ability to use data analytics to drive decision-making and program improvements.
  • Strong critical thinking and problem-solving skills in complex healthcare settings.
  • Deep understanding of healthcare regulations, including Medicare Advantage, CMS, NCQA, and URAC accreditation standards.
  • Ability to craft clear, concise executive-level reports, presentations, and communications.
  • Ability to develop scorecards and key performance indicators to monitor program success.
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