Senior Director, Clinical Services

Job ID: J129122
Company: Gateway Health Plan
Location: Pittsburgh, PA, United States
Full/Part Time: Full time
Job Type: Regular
Posted at: Aug 7, 2018

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Description

JOB SUMMARY

This job provides strategic direction by leading the effort to create and maintain program development, implementation and evaluation of the utilization management, case management, and disease management programs impacting health for individuals and populations. The initiatives incorporate the regulatory and contractual requirements of the related contracts into the programs and include development and monitoring of clinical programs and care initiatives for plan performance and the implementation of population based studies. All performed activities span the service area as well as nationally. Defines and communicates program strategy and ensures activities are in alignment with corporate vision and strategy.

ESSENTIAL RESPONSIBILITIES

  • Perform management responsibilities to include, but are not limited to: involved in hiring and termination decisions, coaching and development, rewards and recognition, performance management and staff productivity. Plan, organize, staff, direct and control the day-to-day operations of the department; develop and implement policies and programs as necessary; may have budgetary responsibility and authority.
  • Lead the identification, development, management and direction of innovative program offerings that align with the Enterprise corporate strategic and business goals to meet customer needs and market growth while ensuring program effectiveness and efficiency. Create and communicate a vision of success for the department, delineating measurable goals that are consistent with, and contribute to, achievement of high level of quality, service, and outcomes.
  • Lead the planning, development, and implementation of major policy and business initiatives.   Assist in review and approve contracts and legal documents related to clinical services and clinical performance.  Establish operational as well as outcome monitoring systems related to clinical improvement initiatives. In conjunction with medical staff, oversee the planning, implementation, direction, evaluation and continuous improvement of the organization’s use of medical management.
  • Stay current with industry best practices to develop and lead strategic and operating plans. Oversee the development and execution of these plans.
  • Oversee the periodic review of internal and external benchmark data, quality management data, and risk management data for the purpose of prioritizing clinical improvement initiates to align with corporate strategies and vision. 
  • Interact with providers, vendors, members, regulators and other outside organizations/persons in a manner that assures a representative and liaison to external stakeholders, including local, state, federal/national regulatory entities.
  • Other duties as requested.

EDUCATION

Required

  • Bachelor's Degree in Nursing

Substitutions

  • None

Preferred

  • Master's Degree Health Related

EXPERIENCE

Required

  • 7 years Nursing
  • 7 years Leadership

Preferred

  • None

LICENSES or CERTIFICATION

Required

  • Registered Nurse

Preferred

  • None

SKILLS

  • Strong analytic skills and a broad working knowledge of current health insurance accreditation guidelines and applicable government regulations
  • Proven leadership skills; ability to influence and motivate others to achieve results
  • Strong and effective verbal and written communication skills and ability to present complex topics in a concise manner
  • Broad understanding of strategic business issues, metrics, organizational linkages and customer value
  • Excellent analytical skills, with the ability to assess scenarios based on  real-world applications
  • Successful experience in achieving results through people in a complex environment
  • Ability to motivate staff to meet strict project and reporting deadlines
  • Ability to focus on details, but with an overall understanding of the business
  • Ability to provide sound project direction, interact effectively with senior management and others within the corporation, and facilitate project assessments, present findings, status and recommendations in a professional manner
  • Must be methodological in problem resolution while considering multiple resources  both inside and outside the company and multiple tasks
  • Ability to recognize and balance business and operational constraints without jeopardizing compliance

Language (Other than English)

None

Travel Requirement

(0% - 25%)

PHYSICAL, MENTAL DEMANDS and WORKING CONDITIONS

Position Type

Office-Based

Teaches / trains others regularly

Frequently

Travel regularly from the office to various work sites or from site-to-site

Occasionally

Works primarily out-of-the office selling products/services (sales employees)

Never

Physical work site required 

Yes

Lifting: up to 10 pounds

Frequently

Lifting: 10 to 25 pounds

Rarely

Lifting: 25 to 50 pounds

Rarely

Disclaimer: The job description has been designed to indicate the general nature and essential duties and responsibilities of work performed by employees within this job title. It may not contain a comprehensive inventory of all duties, responsibilities, and qualifications required of employees to do this job.

Compliance Requirement: This position adheres to the ethical and legal standards and behavioral expectations as set forth in the code of business conduct and company policies.

Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities, and prohibit discrimination against all individuals based on their race, color, religion, sex, national origin, sexual orientation/gender identity or any other category protected by applicable federal, state or local law. Highmark Health and its affiliates take affirmative action to employ and advance in employment individuals without regard to race, color, religion, sex, national origin, sexual orientation/gender identity, protected veteran status or disability.
EEO is The Law
Equal Opportunity Employer Minorities/Women/ProtectedVeterans/Disabled/Sexual Orientation/Gender Identity (http://www1.eeoc.gov/employers/upload/eeoc_self_print_poster.pdf)
We endeavor to make this site accessible to any and all users. If you would like to contact us regarding the accessibility of our website or need assistance completing the application process, please contact number below.
For accommodation requests, please call HR Services at 844-242-HR4U or visit HR Services Online at HRServices@highmarkhealth.org

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