Director and Medical Management SME
Description
The Director and Medical Management Subject Matter Expert (SME) will report to the Principal & EVP of Medical Management and will work closely with firm leadership to manage and support consulting engagements and business development opportunities – particularly those related to payer or provider medical management areas including care management, UM and UR.
The Director must be able to effectively manage major engagements, business development projects and team members while maintaining excellent client rapport and developing value-add content to support client engagements. The successful candidate must have in-depth knowledge of the health care environment and market issues at the federal, state and local level, and must posses a valid Registered Nursing (RN) license in the state of practice.
FLSA Status | Exempt | Salary Range | $150,000-$180,000 |
Reports To | Principal & Medical Management Service Line Leader | Direct Reports | None |
Location | Onsite / LA office 2-3 days per week and at client sites as needed. | Travel | Up to 80% |
Work Type | Regular | Schedule | Full Time |
Position Description:
- Help develop value-add consulting services and products for hospitals, health systems, health plans and mid-to large-size physician organizations
- Manage all assigned aspects of consulting engagements and other assigned contracts and projects from scope definition to delivery, assuming ultimate responsibility for the successful completion of contract deliverables, project resourcing and budget management
- Maintain and build out new tools, templates and configurable workflows as needed to ensure up to date with regulatory and market best practice requirements
- Support development, implementation and maintenance of consulting engagement standards, including technical quality assurance
- Build and manage relationships with key executives and staff at client sites to ensure the success of the engagement(s) and account growth
- Achieve assigned revenue target for Director level, through a combination of new client lead sales and expanded business with current clients
- Responsible for maintenance of quality and risk mitigation standards and plan for account in coordination with senior account leadership, including assessing the effectiveness of strategies deployed
- Develop internal strategic initiatives and propose solutions, teams and resource needs. Lead implementation of proposed recommendations
- Support the professional development and growth of direct reports and team members in line with the values and culture of the organization; serve as a leader/mentor to generate a vision, establish direction, motivate team members, create an atmosphere of trust
- Support business development initiatives at the Director level, including representing the company, and client(s) as appropriate, at various professional networking, public relations and business development events, and developing peer-reviewed articles, sales materials, case studies, internal curricula and trainings
- Ensure compliance with all local, state and federal regulations and ethical standards
Qualifications:
- Valid Registered Nursing (RN) license in the state of practice (CA preferred).
- 5 - 10 years of experience in consulting and/or related operations in a health care setting
- Prior experience in at least two of the following areas strongly preferred:
- Care model redesign for providers and payers
- Care Management / Medical Management Care Models
- Population health management within value based payment models
- Quality assurance and performance improvement
- Regulatory compliance (Medicare, Special Needs Plans, Medicaid, etc.)
- Health plan accreditation (NCQA, URAC, etc.)
- Other clinically-related operations in MSOs, ACOs, IPAs, Medicare Direct Contracting, Clinically Integrated Networks, Centers of Excellence, health plans and other clinical settings
- Behavioral Health care models
- Strong communication and interpersonal skills; experience in managing senior key stakeholder relationships
- A strong understanding of the health care industry and its current trajectory
- High level of proficiency in Excel and other Microsoft Office programs
- Skills related to effective project management, including strong work ethic, attention to detail, time management, ability to prioritize, problem solving, flexibility and willingness to learn
- Open to traveling up to 80% (e.g., Monday – Thursday)
- Flexibility to work evenings and weekends as necessary
- Ability to work effectively on multiple projects with a team in a fast-paced environment
Benefits:
As a firm passionate about health care, we’re deeply committed to the health and wellness of our own team members. We offer comprehensive, affordable insurance plans for our team and their families, and a host of other unique benefits, such as a yearly stipend for wellness-related activities, and a paid parental leave program. You can learn more about our benefits offerings here: https://copehealthsolutions.com/careers/why-cope-health-solutions/.
What We Do:
COPE Health Solutions (CHS) is a national tech enabled services firm powering success in risk arrangements and development of the future workforce for payers and providers. Our team brings deep expertise, experience, proven tools, and processes to improve financial performance and quality outcomes for all types of payers and providers, de-risking the roadmap to advanced value-based payment.
Our firm has expertise in all aspects of population health, strategy, delivery system development, payment systems reform, workforce development and population health management support services, including peerless analytics and performance improvement. We are driven by our passion to help transform health care delivery, align financial incentives to support population health management and build the workforce needed as health care moves to value-based care.
COPE Health Solutions’ Analytics for Risk Contracting (ARC) Suite provides a powerful array of analytic and reporting tools designed to achieve optimal value and performance for organizations currently in or planning to move to risk-based arrangements. Leveraging our extensive, hands-on expertise in helping IPAs, ACOs and health systems achieve successful outcomes in risk contracts, our team of managed care experts draw insights from the analytic outputs that are tailored to each organization’s unique circumstances to interpret the data and recommend initiatives to help improve total cost and quality.
Our multidisciplinary team of health care experts provides our clients with the experience, capabilities, and tools needed to plan for, design, implement and support both the development and execution of strategy and developing solutions to some of the industry’s most complex problems. We partner with our clients through aligned mission and financial incentives to pursue performance excellence in a challenging and rapidly evolving health care environment.
To Apply:
To apply for this position or for more information about COPE Health Solutions, visit us at https://copehealthsolutions.com/careers/open-positions/.