Director of Provider and Clinical Management

Job ID: J105521
Company: HM Health Solutions Inc.
Location: Eagan, MN, United States
Full/Part Time: Full time
Job Type: Regular
Posted at: Mar 1, 2018

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Description

General Overview:
The consulting workforce leverages combined people, process, and technology competencies  to support large-scale, complex customer engagements; collaborates with Product, Infrastructure, and Security teams to configure solutions and deliver value to customers; acts as subject matter expert and trusted advisor in both practice and customer spaces; and works closely with engagement and practice leadership team to define strategic and tactical direction.


This position will specifically serve as the Provider and Middle Office Team Lead responsible for the client implementation and ongoing operational support for the Provider Management and Middle Office domain areas. Specific oversight will include:

  • Day to day administration of managed care operations in a variety of clinical functions as Utilization Management, Case Management and Disease Management. Partner to support team efforts, communications, protocols and procedures for managed care activities ensuring the cost effectiveness of health care delivery by an ongoing coordination with other internal departments.  
  • Managing the products, processes and procedures to best serve the Provider network and allow the program to be successful. Increase and / or improve the product for each health plan partner and seek medical cost saving programs for all members in the market. Works daily to improve the relationships with health plan providers and resolve any outstanding issues that may develop. 

The Associate Principal is responsible for driving customer value through client facing advisory and delivery services in support of HM Health Solutions product offerings. This position is also focused on all areas of healthcare management including medical policy, utilization management, care management and wellness. Acts as leader in practice area, support pre-sales and sales activities

Accountabilities include, but are not limited to, leading major workstreams and projects, supporting pre-sales and sales activities, owning deliverables, building key customer relationships, building and sharing institutional knowledge, and developing junior professionals.


This position is located in Minneapolis, MN.


Essential Job Functions:

  • Contribute to the delivery and execution of complex, large scale, multi-year (high cost, high complexity and/or high risk) client enterprise transformation programs by: gathering required data through direct observation and/or inquiry and synthesizing data into meaningful observation; analyzing, identifying and problem solving from information sets (issues could be business or systems issues) drawing conclusions from information sets based on analysis, creating hypotheses and presenting recommendations to team; developing client specific requirements, standard operating procedures, functional roles & responsibilities, process flow and userguides.Plan, organize, staff, and direct the day-to-day operations of the Provider and Middle Office domain develop and implement policies and procedures; may have budgetary responsibility and authority.
  • Build, share, and maintain expertise within the practice area and client environment, regularly interface with Product, Infrastructure, and Security teams to deliver on customer commitments.
  • Contribute to operational readiness, organizational change management, solution capability, packaging, and estimating, planning and delivery management.
  • Design and own deliverable artifacts to deliver client value and meet contractual obligations.
  • Lead major engagement workstreams and projects to meet milestones on time, and to deliver with high quality and within agreed to budgets.
  • Contribute to pre-sales and sales activities.
  • Perform personnel management responsibilities including, but not limited to involvement in hiring and termination decisions; coaching, mentoring, and professional development of practitioners; practitioner rewards and recognition; on-going performance management; and evaluation of staff productivity.
  • Other duties as assigned or requested.

Minimum Required Qualifications:
•    Bachelor's Degree Business Administration, Management Information Science, Health Administration, or relevant field
•    8+ years' consulting/and or industry experience
•    Ability to travel up to 80% of the time

Preferred Qualifications:
•    Master's Degree  Business Administration, Management Information Science, Health

Administration, or relevant field
•    8+ years’ experience working creating and supporting data warehouses
•    8+ years’ experience within data analytics and reporting 
•    8+ years' technology platform delivery experience
•    5+ years' healthcare/insurance industry experience
•    5+ years' program/project management experience
•    Experience engaging, influencing, and advising senior executive leaders (both internal and with clients)
•    Experience working in complex matrixed environments.
•    Project Management Professional, Information Technology Infrastructure Library

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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