Clinical Transformation Manager



Clinical Transformation Manager Washington, DC

Title: Clinical Transformation Manager (Payer Ops)

Job Type: Permanent

Primary Location:  Major Cities in USA

The Challenge:

As a Manager, you’ll work as part of a team of problem solvers, helping to solve complex business issues from strategy to execution.

Role & Responsibilities:

  • Develop new skills outside of comfort zone.
  • Act to resolve issues which prevent the team working effectively.
  • Coach others, recognize their strengths, and encourage them to take ownership of their personal development.
  • Analyze complex ideas or proposals and build a range of meaningful recommendations.
  • Use multiple sources of information including broader stakeholder views to develop solutions and recommendations.
  • Address sub-standard work or work that does not meet firm’s/client’s expectations.
  • Use data and insights to inform conclusions and support decision-making.
  • Develop a point of view on key global trends, and how they impact clients.
  • Manage a variety of viewpoints to build consensus and create positive outcomes for all parties.
  • Simplify complex messages, highlighting and summarizing key points.
  • Uphold the firm’s code of ethics and business conduct.

Essential Skills & Requirements:

  • Minimum Degree Required: Bachelor Degree
  • In lieu of a Bachelor Degree, 12 years of professional experience involving technology-focused process improvements, transformations, and/or system implementations.
  • Minimum Years of Experience: 5 year(s)
  • Degree Preferred: Master Degree
  • Preferred Fields of Study: Actuarial Science, Business Administration/Management, Finance, Nursing, Health Administration
  • Additional Educational Preferences: Master of Health Care Admin/Master of Public Health
  • Demonstrates extensive abilities and/or a proven record of success as a team leader supporting large teams through the design and implementation of changes to Middle Office Operations, including people, process and technology by the following:
  • Having prior consulting or project-based experience;
  • Identifying, addressing and managing client needs related to building, maintaining, and utilizing networks of client relationships and community involvement;
  • Communicating value propositions, utilizing PC applications such as Microsoft Word, Excel, PowerPoint and project to write and deliver proposals to prospective clients;
  • Managing and overseeing resource requirements, project workflows, budgets, billing and collections;
  • Preparing and/or coordinating complex written and verbal materials;
  • Supervising teams to create an atmosphere of trust and seeking diverse views to encourage improvement and innovation;
  • Answering questions and providing direction to less experienced staff;
  • Working experience in Payer Middle Office operations (domain areas such as Medical Management, Population Health Management, Utilization Management, Provider Network Management, Value-Based Contracting, Provider Relations, Quality Improvement, Program/Payment Integrity, Risk Adjustment and Pharmacy Benefit Management) to help payers manage their medical costs;
  • Working experience in Clinical Analytics, Actuarial, Medical Economics, Claims groupings (e.g., ETG), and Population Health Analytics or working in collaboration with related functions;
  • Working experience with Population Health Management technologies and approaches (e.g., high-risk user stratification tools, cost/quality/utilization trend analysis, provider performance tools);
  • Working experience with Provider Network contracting domains including: value-based / risk contracting; specialty and behavioral health contracting; provider performance incentive management; alternative model contracting strategies, such as with community-based organizations and social needs providers; and,
  • Understanding of global trends for health organizations utilizing pragmatic approaches to achieve sustainable financial functions and operating models.


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