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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