Director, Health Management

<strong>Working at Advantasure is more than a job &mdash; you&rsquo;re part of a team that is becoming the country&rsquo;s leading healthcare solutions provider.<br /></strong><br /><strong>A career at Advantasure means you&rsquo;ll be part of one of the most dynamic, diversified and innovative healthcare companies in the nation. You&rsquo;ll be helping our clients make their members healthier &mdash; and our communities a better place to call home.</strong>

United States, USA


<p class="p1"><strong>At Advantasure, we partner with healthcare clients to simplify their operations and accelerate their business success. Powered by our broad expertise and a comprehensive suite of product and service solutions, we help health plans effectively navigate the complexity of healthcare.</strong></p>

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Competitive Compensation and Benefits Package

Overview: <br /> <p>Under the direction of the&nbsp;Managing Director of Health Management, this role provides day-to-day leadership and management to a multi-department health insurance services organization. Responsible for driving the Health Management organization to achieve and surpass performance metrics and business goals and objectives. Designs programs and processes which improve patient outcomes and drive down cost of care for our clients and their members. Provides timely, accurate, and complete reports on the operating condition of all assigned areas. Fosters a success-oriented, accountable environment within the organization. Motivates and leads a high-performing organization. Attracts, recruits, trains, develops, coaches, and retains top talent.</p> <p>The Director is responsible for planning, organizing, directing, controlling, and leading the day-to-day operations of the business unit. In collaboration with executive leadership and our clients, this position establishes the vision and sets the strategic direction for the business units, and supports corporate goals and objectives.</p> <p>The Health Management organization is responsible for&nbsp;Care Management, Utilization Management, Disease Management, Medical Management, Population Health, STARS/CAHPS/HEDIS, Medical Policy, Pharmacy Operations, Appeals &amp; Grievance, Client Relationship Management, Vendor Oversight, and new client implementations. Other duties of this role include consulting, client support, program development, and implementation, quality measure improvement programs (Stars, CAHPS, HEDIS, etc), clinical operations, reporting and analytics, as well as collaboration with internal and external stakeholders.<br /><br /></p> <p><strong>WORKING CONDITIONS:</strong></p> <p>Work is performed in an office setting with no unusual hazards. Travel is required.</p>
Responsibilities: <br /> <ul> <li>Provide day-to-day leadership and direction of assigned functional areas</li> <li>Coach, develop, and mentor functional teams</li> <li>Develop, implement, monitor procedures and controls within the organization</li> <li>Serve as a key member of the senior leadership team, handling strategic and tactical responsibilities</li> <li>Plan, develop, organize, implement, oversee and evaluate the work of functions within scope of responsibility</li> <li>Evaluate the results of overall clinical operations regularly and systematically and reports these results to executive team</li> <li>Support development and management of budgets for assigned areas</li> <li>Drive accountability and authentic commitment to inclusive environment in support of objectives</li> <li>Manage and cultivate relationships with clients, parent company, its affiliates, and key stakeholders</li> <li>Work with leaders to develop innovation capabilities and resources to source ideas and drive solutions to implementation.</li> <li>Participates in the development of programs as a strategic partner that supports the company plan.</li> <li>Participates in development of annual departmental budget, monitors budget, and identifies budget discrepancies. Researches cause and makes recommendations.</li> <li>Responsible for balancing workload to optimize the effectiveness of the department.</li> </ul> <br /> <p><strong>DIRECTION EXERCISED:</strong></p> <ul> <li>Directly supervises exempt and non-exempt staff in accordance with company policies and applicable Federal and State Laws.&nbsp;</li> <li>Responsibilities include, but are not limited to, effectively interviewing, hiring, terminating, and training employees; planning, assigning, and directing work; appraising performance; rewarding and counseling employees; addressing complaints and resolving problems; supporting and encouraging the engagement process.</li> </ul>
Requirements: <br /> <p><strong>EDUCATION:</strong></p> <ul> <li>Bachelor&rsquo;s degree in Business Administration, Health Care Administration, Marketing, or a related field.&nbsp;&nbsp;</li> <li>Master&rsquo;s degree in a related field is preferred.&nbsp;</li> <li>Clinical background (e.g. RN) required.&nbsp;</li> <li>Relevant combination of education and experience may be considered in lieu of degree.&nbsp;</li> <li>Valid and unrestricted driver&rsquo;s license is required.&nbsp;&nbsp;&nbsp;</li> <li>Continuous learning, as defined by the Company&rsquo;s learning philosophy, is required.&nbsp;</li> </ul> <br /> <p><strong>EXPERIENCE:</strong></p> <ul> <li>Ten (10) years of progressively more responsible experience in a Business environment with demonstrated technical experience that provides the necessary knowledge, skills, and abilities.&nbsp;</li> <li>7 to 10 years experience working in a health insurance plan, health provider organization, or public health or community-based agency in a similar capacity.</li> <li>Five (5) years management or supervisory experience in Business required.</li> <li>3-5 years of experience in developing health plan delivered Health Management programs. &nbsp;</li> </ul> <p><strong><br /><br />SKILLS/KNOWLEDGE/ABILITIES (SKA) REQUIRED:</strong></p> <ul> <li>Demonstrated leadership experience with Care Management, Utilization Management, Disease Management, Medical Management, Population Health, STARS/CAHPS/HEDIS, Medical Policy, Pharmacy Operations, Appeals &amp; Grievance, Client Relationship Management, Vendor Oversight</li> <li>Recent and related health plan, payor, or business process outsource (BPO, BPaaS) experience</li> <li>Demonstrated ability in using data-driven decision making to design programs and processes which improve patient outcomes and drive down cost of care</li> <li>Ability to lead collaboratively across many teams in a fast-paced, growth-oriented environment</li> <li>Thorough knowledge of health plans, insurance products, and processes</li> <li>Expertise with Medicare Advantage and government insurance programs</li> <li>Ability to recognize interdependencies of process and overall impact of changes</li> <li>Able to build a culture of trust and respect, collaboration, inclusion, and diversity within the organization</li> <li>Excellent communication and relationship management skills.</li> <li>Able to conceptualize and develop new ideas and opportunities for improvements, proactively assess the impact of emerging industry, economic &amp; competitive trends</li> <li>Knowledge of high-performing team building and employee motivation theories with the ability to effectively manage employee teams across multiple locations.</li> <li>Ability to appropriately manage resources, budgets, issues, and risks for the successful completion of business goals</li> <li>Excellent oral and written communication, as well as presentation skills.</li> <li>Ability to anticipate business needs and implement processes and products that support them</li> <li>Ability to establish rapport and maintain customer satisfaction without compromising priorities.</li> <li>Ability to interact with others at all levels of the organization, build consensus, and drive objectives to completion</li> </ul>