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Program Manager, Clinical Oversight CM UM in Southfield, MI at AF Group

Date Posted: 5/11/2018

Job Snapshot

Job Description

COBX

Senior Health Services







SUMMARY:



The Program Manager is responsible for providing oversight of strategic programs and related financial functions for Medicare Advantage Medical Management. This role collaborates with multiple functional areas requiring a combination of focus and flexibility, as well as a willingness to play an active, behind-the-scenes role. It provides oversight of various enterprise projects and initiatives from ideation through development, approval and execution. The Program Manager exercises broad discretion and judgment in the acquisition and dissemination of information. The role is highly collaborative and facilitative and works closely with the team to develop annual and long-term plans and transition of ideas to implementation. The Program Manager understands multiple perspectives of health care, government programs, nonprofit and for-profit business, operational issues and the impact. This role is responsible for oversight of Medicare Advantage programs related to Utilization Management, Care Management, and Quality



RESPONSIBILITIES/TASKS:




  • Plans, organizes, and directs activities of assigned initiatives and programs.
  • Grows, evolves and refines governance model seeking consensus on prioritization of requests in cooperation with impacted departments and respective committees.
  • Leads program meeting and facilitates prioritization and implementation issues / conflict resolution with appropriate Department Heads and Senior Leadership.
  • Leads meetings and drives key decisions with all stakeholders to define project initiation requirements, ongoing monitoring, and success criteria.
  • Drives key decisions with all stakeholders to define project initiation requirements, ongoing monitoring, and success criteria.
  • Establishes a refined body of metrics related to intake, execution, and delivery of the Medical Management portfolio.
  • Drives communications and publishes dashboard medical management portfolio management.
  • Proactively follows-up on open issues with senior leadership, as well as other relevant parties, in order to implement solutions in a timely fashion.
  • Works with project managers and business leads to develop business cases, understand project scheduling and outcomes.
  • Maintains and provides information about current projects and potential future projects as required.
  • Develops, prepares, and distributes project portfolio reports (monthly at a minimum or more frequently as needed).
  • Clearly communicates policies and procedures as they relate to governance management and metric reporting.

    This position description identifies the responsibilities and tasks typically associated with the performance of the position. Other relevant essential functions may be required.





    EMPLOYMENT QUALIFICATIONS:





    EDUCATION:



    Bachelor's degree in Business, healthcare, or a related field. . Masters in healthcare administration, business or public health is preferred. RN preferred. Relevant combination of education and experience may be considered in lieu of degree. Continuous learning, as defined by the Company's learning philosophy, is required. PMP certification or progress toward certification is preferred and encouraged.



    EXPERIENCE:



    A minimum of seven years of multi-faceted experience in the healthcare industry, project management environment or a related field with demonstrated technical knowledge that provides the necessary skills, knowledge, and abilities. Utilization Management or Care Management experience in a managed care setting required.



    SKILLS/KNOWLEDGE/ABILITIES (SKA) REQUIRED:




  • Demonstrated leadership skills.
  • Excellent verbal, interpersonal, and written communication skills.
  • Strong project management leadership, facilitation, negotiation, team coaching, and collaboration skills.
  • Knowledge of industry best practices, with regard to program and project management principles and tools.
  • Proven ability to work independently in a team-oriented environment.
  • Understands capabilities, skill sets, and interests of resources and factors into staffing decisions.
  • Understands staffing plans and staffing progress along with utilization and group bandwidth.
  • Ability to plan and carry out responsibilities with minimal direction.
  • Strong organizational skills and ability to handle multiple tasks in a fast-paced environment.
  • Ability to manage multiple priorities and meet necessary deadlines.
  • Ability to effectively exchange information clearly and concisely, present ideas, report facts and other information, respond to questions and employ active listening techniques.
  • Ability to apply the principles of independent logical, analytical thinking to define problems, collect data, establish facts and draw valid conclusions.
  • Ability to interact with others to build consensus and get decisions implemented.
  • Demonstrated task and relationship management skills.
  • Results-oriented and ability to manage multiple tasks simultaneously.
  • Ability to handle sensitive and confidential information.
  • Knowledge of Microsoft packages, including Project, PowerPoint, Word, and Excel.
  • Strong understanding of the importance for detail.
  • Skilled at managing stakeholder groups and balancing diplomacy and tact with assertiveness.
  • Excellent prioritization skills to balance key priorities.
  • Strong customer centric approach.
  • Effective in unifying and creating teams of people with disparate skills.
  • Courageous and decisive, prioritizes effectively, maintains a clear focus, and sees action through to delivery.
  • Energetic, determined, positive, goal focused and consistent, even when under pressure.
  • Ability to build trust and demonstrates integrity in all circumstances.



    WORKING CONDITIONS:



    Work is performed in an office setting with no unusual hazards. Occasional travel required.

    The qualifications listed above are intended to represent the minimum education, experience, skills, knowledge and ability levels associated with performing the duties and responsibilities contained in this job description.

    We are an Equal Opportunity Employer. Diversity is valued and we will not tolerate discrimination or harassment in any form. Candidates for the position stated above are hired on an "at will" basis. Nothing herein is intended to create a contract.

    Equal Opportunity Employer Minorities/Women/Protected Veterans/Disabled