Description
Reports directly to the Vice President, Medical Management Operations and serves as a member of the HGB Executive Committee. Leads functions related to HGB's Care Management programs to include predictive models, engagement strategies, intervention and corresponding support. Also leads Utilization Management to include Policy, Appeals & Denials, and integration with Claims adjudication. Collaborates with Medical Directors and other leaders within Medical Management, HGB and Humana to develop Population Health strategies to improve overall health; meet DoD readiness requirements; and provide a best value approach for the TRICARE line of business. Meet contract deliverables and performance guarantees while focusing on improving clinical and financial outcomes for the TRICARE population and enhancing the beneficiary experience.
Responsibilities
This individual has the following responsibilities:
Build and execute strategic plans to meet HGB and Medical Management strategic objectives and key results while also leading both MM team and cross-functionally to gain alignment and execute
Responsible for the oversight of 4 departments, and growth of directors and associate director, fully developing leaders of leaders: Case Management, Disease Management / Personal Nurse, Utilization Management / Appeals, and Experience and Optimization team.
Develop, challenge, and grow direct and indirect reports to capitalize on HGB talent through building developmental plans at a 95% compliance rate for Supervisors and above; ensure succession plans are in place for all leaders; and actively promote Humana self-learning opportunities to improve business and leadership acumen
Create a culture of innovation, collaboration, and high performance operations by organizing and leading cross-functional team to advance HGB and/or Medical Management objectives
Identify opportunities to improve the beneficiary experience, operational performance, and/or financial performance; gains Executive Committee approval; and builds multi-disciplinary teams
Lead complex transformational changes that require strategic planning / visioning, leading cross-functionally to gain buy-in and then execute through extensive project planning; significant resources; and broad coordination across HGB and Humana (if applicable) to advance the HGB mission; support strategic objectives; promote the HGB / Humana brand
Meet contract deliverables and contract performance guarantees at a 99% rate on a monthly basis
Develop leading operational metrics that ensure contract deliverables and performance guarantees are met
Develop and deliver on process improvement initiatives that help HGB maintain a competitive cost and performance position; reduce operational & contract risk; improve operating outcomes for HGB; and build capacity for new capabilities
Know the TRICARE Operating Model within Medical Management so it may be fully leveraged for future business opportunities while also identifying opportunities to apply leading industry and Humana practices within HGB
Serve as the strategic and operational subject matter expert for the designated responsible functions while also focusing on HGB overall strategy
Collaborate with Humana and HGB leaders to share and obtain lessons learned for consistency and quality across multiple contracts and business lines
Drive innovation internally within the team and identify innovative opportunities for application in HGB and Medical Management
Identify, communicate, and prioritize IT and Analytics projects that support complex problems / operations that have a longitudinal impact within HGB
Evaluate and adapt to contract change orders; communicate change orders to applicable team(s); identify required resources related to the change order; and modify processes to meet government requirements
Execute the guidance and vision provided by senior HGB and Medical Management leadership
Serve on the Executive Committee as a contributor and advisor to develop HGB strategic objectives; improve HGB performance; ensure initiatives do not compromise morale and well-being of the associates; and mitigate operational and contractual risk
Represent the VP, Medical Management Operations as required
MINIMUM QUALIFICATIONS
Bachelor's Degree
Graduate degree in relevant field, business or health care administration preferred
10 years of leadership experience in Government Contracts, Business Development, Management, Medical Operations, or other relevant/related experience
Experience in Military or Government healthcare preferred
KNOWLEDGE, SKILLS, ABILITIES
Excellent written and verbal communication skills at multiple levels
Ability to apply the principles of independent logical thinking to define problems, collect data, establish facts, draw valid conclusions, and make strategic recommendations
Ability to integrate and coordinate content from various sources to establish deliverables for multiple stakeholders and hold others accountable for delivering
Ability to synthesize information from a variety of resources to present or address an issue or to answer a question
ADDITIONAL INFORMATION
Willing to consider various locations but will require monthly travel to Louisville at times
Scheduled Weekly Hours
40
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